Injury Report Form - Online PIlot - Jr. Teams

Hockey Alberta is undertaking a pilot project with Junior A teams in Alberta to develop a more efficient manner to process and follow up on Hockey Canada Injury Report forms. The goal of Hockey Alberta is establish a process where it is easier to track the progress of the claim.

The pilot project will see an additional step in the form submission process in the aftermath of an injury. The pilot process will include:

  1. The Hockey Canada Injury Report Form must be downloaded and filled out completely.
  2. This online version of the Injury Report Form must also be filled out.
  3. As part of submitting this online form, you are required to upload a PDF of the official Injury Report form.

If there are questions, or if issues arise with this form, contact Allison Marriott, Coordinator, Hockey Operations.

Hockey Canada Injury Report

Forms must be filled out in full or form will be returned. This form must be completed for each case where an injury is sustained by a player, spectator or any other person at a sanctioned hockey activity.

Required Fields *


Injured Participant

() - -


Division/ Category

Check at least one of the following:












Body Part Injured



On Site Care



Injury Conditions

Check at least one of the following:








Check all that apply:









Team Information



Health Insurance Information



Physican’s Information

() - -


Dentist Statement

() - -


Hockey Canada Injury Report



Forward Submission

If you wish to forward this form submission to other related person(s) please enter their email addresses below, separated by commas. (ex: info@example.com,person2@example.com)