Serious injury reports must be completed for the following injuries:

  • Any head or neck injury that requires the player to be transported directly from the ground to an emergency department, hospital or after hours medical centre.
  • Any injury that results in the admission of a player into hospital after a game.
  • Any injury that is expected to prevent a player from playing for a period of 8 weeks or longer.

Serious injury reports must be submitted to the Provincial union headquarters within 48 hours of the injury coming to the notice of the referee or team management.

Please fill in the form below for qualifying serious injuries.

Player's Details

Player's Gender (required)

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Type of Injury
ConcussionDislocationSerious JointOther (specify in extra details below)

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On-Field Treatment Provider
DoctorSt JohnsTeam OfficialRefereeOther (specify in extra details below)

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Method of Leaving the Field
AmbulanceStretcherOther (specify in extra details below)

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Site of Injury
HeadNeckShoulderBackArmChest/TrunkThigh/HamstringKneeLower LegOther (specify in extra details below)

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Phase of Play
ScrumLineoutRuckMaulTackleOther (specify in extra details below)

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Accident Details

Extra Details

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Referee Details

Email