CEP Level 3 Manual - Rushmore Hockey Association

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T A B L E O F C O N T E N T SSAMPLE 3 X 5 CARDSUMMARY OF SEASON INJURIESMEDICAL INFORMATIONPlayer’s Name __________________________________Address _____________________________________________________________________________________Parent’s Name__________________________________Telephone: ___________ ___________ ____________Home Work AlternateIn an emergency, if parents cannot be contacted, notify:Name _________________________________________Phone(s): __________________ ___________________WorkHomeDoctor’s Name _________________________________Telephone(s): ________________Day_________________EveningPast Injuries ____________________________________Restrictions/Allergies ____________________________Hospital Preference ___________________________________________________________________________INJURY TYPE FIRST 4 WEEKS MIDDLE WEEKS LAST 4 WEEKS TOTAL1. Back or Neck Injury2. Blisters3. Bruise4. Dental Injury5. Dislocation6. Fracture7. Head Injury –Conscious8. Head Injury –Unconscious9. Lacerations10. Loss of Wind11. Nose Bleed12. Skate Bite13. Sprain14. Strain15.16.17.Do you see a trend? YES NOSteps to take to reduce injuries next season:(1) _____________________________________________________________________________(2) _____________________________________________________________________________(3) _____________________________________________________________________________(continued on reverse side)76 | USA Hockey Coaching Education Program Level 3 ManualRisk Management | 77
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