Codes and Policies

Report an Injury

To report a serious injury, please provide the following information within 48 hours of time of incident.

Competition Type*

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Club/School*

Player Name*

Birth Date*

MyRugby ID

Gender*

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Role*

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Address

Phone*

Email*

Emergency Contact

Name*

Address

Phone

Injury

Date*

Time*

Scene*

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Site of Injury*

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Type of Injury*

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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?*

Did the player return to the field?*

Who provided on-field treatment?*

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Treatment provider name

Contact Number of treatment provider

What treatment was provided, if any?

How did the player leave the field?*

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What hospital was the player taken to?

Person who accompanied the player

Who accompanied the player?

Accompanied contact number

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

Match

Match home or away*

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Home Team

Away Team

Grade/Age*

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Association*

State*

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Match Official

Venue

Field Conditions

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Weather Conditions

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Was the match stopped?*

If so, for how long?

Did the game restart?*

Is there video footage of the game?*

Club/School/Union - Submitting Report

Contact Name*

Role at Club/School/Union?*

Email*

Phone*

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

Please ensure all required fields are completed before clicking 'submit'.

You will receive an email notification if the case has been submitted successfully.

If you do not receive an email, your case has not been successfully completed and you may need to complete the incident form again.

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