ࡱ> BDA7 bjbjUU %&7|7|7l8,%,rEX3%5%5%5%5%5%5%$& (Y%Q?@Y%%03%3%r$T3%  04 %3%%0%%%|)|)3%RFU REPORTABLE INJURY EVENT REPORT FORM Please use this form to report any injuries that occur whilst playing rugby or taking part in organised squad rugby training sessions that fit any of the following definitions: An injury which results inadmission to a hospitalintensive care unit, high dependency unit, specialist spinal or head injury unit. Deaths which occur during or within 6 hours ofa game finishing. Any injury that is likely to result in an insurance claim to the RFU insurers  Date of report:  FORMTEXT       Time of report:  FORMTEXT       Date of injury:  FORMTEXT       Time of injury:  FORMTEXT       Player's name:  FORMTEXT       DOB or Age:  FORMTEXT       Club/School:  FORMTEXT       Team:  FORMTEXT       Game:  FORMCHECKBOX  Training:  FORMCHECKBOX  Nature of suspected injury:  FORMTEXT       Category:  FORMCHECKBOX  An injury which results inadmission to a hospitalintensive care unit, high dependency unit, specialist spinal or head injury unit.  FORMCHECKBOX  A death which occurred during game or within 6 hours ofa game finishing.  FORMCHECKBOX  An injury that is likely to result in an insurance claim to the RFU insurers Game Injuries Only Opposition Club:  FORMTEXT       Team:  FORMTEXT       Venue:  FORMTEXT       Name of Referee:  FORMTEXT       Name of reporting person:  FORMTEXT       Position within Club/School:  FORMTEXT       Contact Telephone Number(s):  FORMTEXT        Once completed, please send this form to the RFU Sports Injuries Administrator: Email:  HYPERLINK "mailto:sportsinjuriesadmin@therfu.com" sportsinjuriesadmin@therfu.com Fax: 0870 143 2423 Tel: 0870 143 2421 Post: Sports Injuries Administrator, Rugby Football Union, Rugby House, Rugby Rd, Twickenham, TW1 1DS. The RFU only uses this data for contacting individuals and/or their clubs who are identified as requiring support in the case of a seriousinjury.     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