EBYFC Football

Medic Reporting

On-site medical staff use this form to log a player injury during a game.

For Game-Day Medics

Report a Player Injury

Please complete this as soon as it's safe to do so after treating a player. Fields marked with an asterisk (*) are required. The league is notified the moment you submit, and you'll receive an email confirmation of what was logged.

Before you fill this out

Call 911 first for any emergency — this form is a record, not a way to summon help.
Make sure the athlete is stabilized and attended before you step away to complete this.
Submit one report per injured player.
Keep your own records as your certification and protocol require.

Player First Name *

Player Last Name *

Age Group *

Division *

Week *

Game *

Injured Player's Team

Player Jersey Number

Notes on What Happened *

Medic's Name *

Medic's Phone *

Medic's Email *

Medical Credential *

Credential Number *