Blue Card Incident

What happened?

:
(Please enter in 24 hours time format eg: 17:15)
(Please enter the venue/school or field name)

Tell us who you are

Tell us who you are ?

Who was involved

Who was involved

Add Additional contacts

Add Additional contacts

Click on the ADD button to add a contact or more contacts to include in the communication for this incident report. You will be limited to a maximum of 4 contacts.

Consent

SA Rugby Injury and Illness Surveillance and Prevention Project (SARIISPP)

BLUE CARD HEAD/CONCUSSION INJURY DATA FOR SARIISPP

I hereby provide informed consent that the captured Blue Card head/concussion injury information, may be used by SA Rugby and their nominated research partners for injury record and research purposes.

By continuing with the process of logging or documenting this event, I provide informed consent to SA Rugby and their nominated research partners, to access all relevant information pertaining to the rugby-related Blue Card head/concussion injury.

I furthermore agree to release to SA Rugby, all Blue Card head/concussion injury data sustained during any SA Rugby associated leagues or tournaments, which may include, but are not limited to Currie Cup, and any other amateur community rugby matches and training associated with SA Rugby, the local Provincial Rugby Union, Club or School affiliated rugby activities.

The Blue Card head/concussion injury data, as stipulated above, may or may not be used for research purposes. This information will be stored at SA Rugby’s offices for official records of these rugby- related injuries.

The Blue Card head/concussion injury data may be used for research and publication purposes to help improve the safety standards of the game of rugby played in South Africa, and can be used to potentially prevent other similar injuries from occurring in the future.

I further understand and acknowledge that all analysed, researched or published information, will be depersonalized, will remain anonymous, and will be treated and handled with the utmost confidentiality.