Codes and Policies

Report an Injury

Competition Type or Event*

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Club/School/Event Name*

Injured Person's Details

Injured Person's Name*

Birth Date*

MyRugby ID (check your MyRugby ID in Rugby Xplorer)

Gender*

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Role*

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Address

Phone*

Email*

Emergency Contact for Injured Person

Name*

Address

Phone*

Injury Details

Date*

Time*

Scene*

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Site of most significant Injury*

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Type of most significant Injury*

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Is there any further information about the injury you can provide (including other injuries in the same incident)

Has/was the injured person admitted to hospital for treatment of their injury(s)?*

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Phase of Play*

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Stage of Game*

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How did the injury occur?

Did the player leave the field?*

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Who provided on-field treatment?*

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Treatment provider name

Contact Number of treatment provider

What treatment was provided?

Person who accompanied the player

Who accompanied the player?

Accompanied contact number

Update on injured player, if known (e.g. released from hospital)

Match Details

Match home or away

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Home Team Name

Away Team Name

Grade/Age*

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Association*

State*

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Venue

Field Conditions

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Weather Conditions

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Match Official Name

Was the match stopped?*

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Is there video footage of the game?*

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Details of Person Submitting Report

Contact Name*

Role at Club/School/Event/Union?*

Email*

Phone*

*I certify that the above information is true and correct.

Please ensure all required fields are completed before clicking “submit”.

Both the person submitting the report and the injured person will receive an email notification if the case has been submitted successfully. Please be sure to check junk mail or other email filters.

If you don't receive an email, please contact Rugby Australia's Community Rugby Team with your name and date your injury report was submitted to communityrugby@rugby.com.au

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