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MENU
About Us
FSC Structure
Contact & Account Details
Corporate Documents
Annual Year in Review
Governance
FSC By-Laws
Corporate Brochure
Strategic Plan
Life Members
Sponsors
Unification
History – Junior Competition
Clubs
Our Clubs
Club Advertisements
Club Changer Development Program
Club Memo and Communication
Grounds
Coach Education
Competitions
Season Calendar
Winter Football
Summer Football
Five A Side Competitions
Walking Football
Walk the Field 2025
Dribl
Development Programs
Referees
Upcoming Courses
Information and Registration
Education and Development
FAQ – Referees
Resources
RESOURCES
Synthetic Pitch
Signage Opportunities
Synthetic Pitch Hire
Reporting an Injury
FSC Injury Report
This form is for reporting an injury from football.
Step
1
of
3
33%
Introduction
This form is to notify Football South Coast of an injury which has occurred at a Football Event.
Reporter's Details
Your Name
*
First
Last
This is the name of the person submitting this form
Email address
*
This is the email address for the person submitting this form
Club Associated with
*
If you are not associated with a club put NA
Reporter's Age
*
Adult (over 18)
High School (12 - 18)
Primary School (6 - 12)
Please choose one of the options
I wish to report an accident/injury which has occurred to
*
Myself
Another Person
My role at the football event was as a
*
Player
Parent
Team Official - (Coach / Manager)
Spectator
Club Official
Match Official (Referee or Assistant Referee)
FSC Offical
Other
Injury Details
Name of person who had the Injury
*
First
Last
Date when the Injury Occurred
*
DD slash MM slash YYYY
The injury occurred during
*
Football Training
Football Match
Other Event
Age Group of Match
*
Senior (19+)
U18
U17
U16
U15
U14
U13
U12
U11
U10
U9
U8
U7
U6
Home Team
*
Away Team
*
What was the event?
*
Venue
*
When did the accident or injury occur?
*
Approximate time e.g. 1:30pm or 1st half of match or 2nd half of match
Where did the accident/ injury occur?
*
Was it on the field, sideline, canteen area, seating, ...
How did the accident / injury occur?
*
What were the injuries / suspected injuries?
*
What treatment for injury / injures (if any) was provided and by whom?
Was an ambulance called?
*
Yes
No
Any Additional Information?
Note
This is not a claim form - only a notification to FSC. To commence an insurance claim, you must use the ONLINE - Gow Gates - Personal Injury Claim Form.
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