Please provide the information to the PMHA regarding what injury happened, where, when and to whom in this brief submission section.
what city or arena did the injury incident take place in?
please list the date and time that the injury took place
Please provide if this information is known at the time of completing this form. This would specifically refer to what happened at the rink. Example answers: player sent to hospital, player went home with parent, player will seek medical followup, player was bandaged and continued to play, coach that was injured has to leave the ice and rest in the dressing room
was an injury reported completed?
Please provide the name of the Team Designate who is completing and submitting this form.
please list the position on the team of who is completing this form
Example: yo[email protected]. Your submission will be sent to this address.