2003 MIF
Name-- Last:________________ First:________________ Age:_______
Date:_________________ Location:___________________
Where did the injury take place:___________________________________________________
When did the injury take place:____________________________________________________
How did the injury occur:_________________________________________________________
Where was the injury(part of body):_________________________________________________
Was it a head/neck injury:________________________________________________________
Was the injured player unconscious:________________________________________________
Was the hit/slash illegal:__________________________________________________________
Was the injured player wearing equipment:___________________________________________
Was the equipment altered/doctored:________________________________________________
Were all straps and buckets properly fastened:________________________________________
Did the injury player hit the boards/ground:___________________________________________
Did the injured player hit the net:___________________________________________________
Was the injury from fisticuffs:______________________________________________________
Was the hit intentional:___________________________________________________________
Was the game meanful:__________________________________________________________
Did the non-injured player need the ball:_____________________________________________
Was dangerous equipment being worn by the players:__________________________________
Was the injured player bleeding:___________________________________________________
Was the injured player vomiting:____________________________________________________
Were there any broken/chipped/fractured bones:_______________________________________
Was the injury a result of a lossie:__________________________________________________
Could the injured player continue to play:_____________________________________________
How much medical treatment was needed:___________________________________________
Was the ambulance needed/called:_________________________________________________
Was the game chippy/dirty:_______________________________________________________
Was that part of the players body all ready hurt:_______________________________________
What was the score when the injury occurred:_________________________________________
Was it late in the game:__________________________________________________________
Injured Player:________________________________________(signature)
Non-Injured Player:____________________________________(signature)
Official:_____________________________________________ (signature if available)
All injury forms must be fully filled out/signed by players/officials.
Forms will be sent to MILL Front Office.
Play will go under review by Board of Governors
MILL Office
bandits_rule11@yahoo.com