ࡱ> 9;8 bjbj|:|: 4 PP$R====LT,Y2h==hhhF==hhhh (Rh 0hhhhh| ]:   RFU REPORTABLE INJURY EVENT REPORT Please use this from to report any injuries that occur whilst playing rugby or taking part in organised rugby squad training sessions that fit any of the following definitions: 1. An individual who sustains an injury which results in their being admitted to a hospital. This does not include those taken to an Accident or Emergency Department and allowed home from there. 2. Deaths occurring during or within 6 hours of the game finishing.  Date of report: _____________________ Time of report: _____________________ Date of injury: _____________________ Time of injury: _____________________ Player's name: _____________________ DOB or Age: _____________________ Club/School: _____________________ Team: _____________________ Game:  FORMCHECKBOX  Training:  FORMCHECKBOX  Grass Pitch:  FORMCHECKBOX  Artificial Grass Pitch:  FORMCHECKBOX  Other Surface:  FORMCHECKBOX  Nature of suspected injury: __________________________________________________ Category: 1 . An injury which results inadmission to a hospital. 2. A death which occurred during or within 6 hours ofa game finishing.  Game Injuries Only Opposition Club: _____________________ Team: _____________________ Venue: _____________________ Name of Referee: _____________________  Injured Player Contact Details: Address: ________________________________________________________________ Phone No: _____________________ Mobile: _____________________ Next of Kin: _____________________ Relationship: _____________________ Phone No: _____________________ Mobile: _____________________  Name of reporting person: _________________________________________________ Position within Club/School: _________________________________________________ Contact Telephone Numbers: _________________________________________________  Once completed, please send this form to the RFU Sports Injuries Administrator: Email:  HYPERLINK "mailto:sportsinjuriesadmin@therfu.com" sportsinjuriesadmin@therfu.com Fax: 020 8892 4446 Tel: 0800 298 0102 Post: Sports Injuries Administrator, Rugby Football Union, Rugby House, Rugby Rd, Twickenham, TW1 1DS. #$ ( c d  % & < N e t u ɸxmxmxxmxmdxmxhc5CJaJhc5CJ\aJhQ0 hc5CJ\aJ"jhcCJUaJmHnHu#hCzXhc5>*B*CJaJph# hc5B*CJaJph# hQ0 hc5B*CJaJph# hQ0 hc5CJaJhQ0 hcCJaJhchQ0 hQ0 5>*CJ$\aJ$hI25>*CJ$\aJ$$#$ = >   T     V ekdh^e`kgdcxgdcgdc$a$gdc   ! " 0 1 2 = ? @ N O P S T _ a b p q r s ԰ԛԆq\)jhL8hc5CJU\aJ)j\hL8hc5CJU\aJ)jhL8hc5CJU\aJ)jthL8hc5CJU\aJ)jhL8hc5CJU\aJjhc5CJU\aJhc5CJ\aJhQ0 hc5CJ\aJhQ0 hcCJaJhcCJaJ$    ! V W Y Z    , - B D E )>K`lŹܞhQ0 hc5>*CJ\aJhc5>*CJ\aJ"jhcCJUaJmHnHuhc5CJaJhQ0 hc5CJaJjhQ0 hcCJUaJhcCJaJhQ0 hcCJaJhc5CJ\aJhQ0 hc5CJ\aJ,   C D F f g ?@#$qrtJgdc$>?qrst'5;IǻһhI2hc5CJaJhQ0 hc0J5CJaJ jhQ0 hc5CJUaJhc5CJaJhQ0 hc5CJaJhQ0 hcCJaJhQ0 hc5CJ\aJhc5CJ\aJ(jhc5CJU\aJmHnHuJ21h:pc. A!"#n$n% tDeCheck1tDCheck3tDeCheck2tDCheck4tDeCheck56666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ Q0 NormalCJ_HaJmH sH tH DA`D Default Paragraph FontRiR  Table Normal4 l4a (k (No List 4U@4 Q0 Hyperlink >*phPK![Content_Types].xmlj0 u$Nwc$ans@8JbVKS(.Y$8MVgLYS]"(U֎_o[gv; f>KH|;\XV!]օ Oȥsh]Hg3߶PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!\theme/theme/theme1.xmlYOoE#F{o'NDuر i-q;N3' G$$DAč*iEP~wq4;{o?g^;N:$BR64Mvsi-@R4Œ mUb V*XX! cyg$w.Q "@oWL8*Bycjđ0蠦r,[LC9VbX*x_yuoBL͐u_. DKfN1엓:+ۥ~`jn[Zp֖zg,tV@bW/Oټl6Ws[R?S֒7 _כ[֪7 _w]ŌShN'^Bxk_[dC]zOլ\K=.:@MgdCf/o\ycB95B24S CEL|gO'sקo>W=n#p̰ZN|ӪV:8z1f؃k;ڇcp7#z8]Y / \{t\}}spķ=ʠoRVL3N(B<|ݥuK>P.EMLhɦM .co;əmr"*0#̡=6Kր0i1;$P0!YݩjbiXJB5IgAФ޲a6{P g֢)҉-Ìq8RmcWyXg/u]6Q_Ê5H Z2PU]Ǽ"GGFbCSOD%,p 6ޚwq̲R_gJSbj9)ed(w:/ak;6jAq11_xzG~F<:ɮ>O&kNa4dht\?J&l O٠NRpwhpse)tp)af] 27n}mk]\S,+a2g^Az )˙>E G鿰L7)'PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 /_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!\theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]     J !1?OaqG G G G G X8@J(  D   jJ"?D   jJ"?DB   o"?DB    o"?DB    o"?JB    o#" ?DB    o"?B S  ?VDr v tg3tg0t T gt( ;t H t Y ltCheck1Check3Check2Check4Check5"@b2Pr!2?Par!2?Par!$0V%J:::#%53c@@@UnknownGTimes New Roman5Symbol3 Arial"hffA+Lf!n24'3QHP ?Q0 2"RFU REPORTABLE INJURY EVENT REPORTXadminUser Oh+'0  ( L X dpx'$RFU REPORTABLE INJURY EVENT REPORTXadmin Normal.dotmUser2Microsoft Macintosh Word@F#@,R@,RA+ ՜.+,D՜.+,h$ hp  'The Rugby Football Union #RFU REPORTABLE INJURY EVENT REPORT Title 8@ _PID_HLINKS'AJ &mailto:sportsinjuriesadmin@therfu.com4  !"#$%&')*+,-./1234567:Root Entry F,R<Data 1TableWordDocument4 SummaryInformation((DocumentSummaryInformation80CompObj`ObjectPool,R,R F Microsoft Word 97-2004 DocumentNB6WWord.Document.8