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Submit injury report
Consent obtained*
I give or have obtained consent for the storage of these injury records.
Your contact details
Full name*
Contact number*
Email address*
Basic information
Injured person
Name*
Phone number*
Email*
Age at the time of injury*
Please select...
Unknown
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Details
Date*
Time*
Venue*
Please select...
30 Berry st, North Sydney
Bunnings Ashfield
Cook and Phillip pool & Victoria Park pool
Cook and Phillip pool, Sydney - Entry Fees
Cook&Phillip / Monte
Fleurieu Aquatic Centre
Online
Sydney International Aquatic Centre
Victoria Park Pool - Entry Fees
How did the injury occur*
Please select...
Collision with fixed object
Collision with other person
Fall/stumble
Jumping
Landing from jump
Overexertion
Overuse
Slip/trip
Struck by ball (e.g. dislocated finger)
Struck by other player
Struck by playing equipment
Temperature-related (e.g. heat stress)
Twisting to pass or accelerate
Other
Description*
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