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Submit injury report
Consent obtained*
I give or have obtained consent for the storage of these injury records.
Your contact details
Full name*
Contact number*
Email address*
Basic information
Injured person
Name*
Phone number*
Email*
Age at the time of injury*
Please select...
Unknown
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Details
Date*
Time*
Venue*
Please select...
Aintree Table Tennis Club
AWTTA Greenfield Park
Bairnsdale Squash & Table Tennis Centre
Ballarat Table Tennis Centre
Ballers Clubhouse
Bendigo & District Table Tennis Stadium
Caloundra Indoor Stadium
Coburg Table Tennis Centre
Eagle Stadium
Geelong Table Tennis Centre
Gippsland Regional Indoor Sports Stadium
Gold Coast Table Tennis Association
Greater Dandenong Table Tennis Centre
Hamilton Indoor Leisure and Aquatic Centre
Horsham Table Tennis Centre
Kilsyth International Table Tennis Stadium
LOOPS Table Tennis Centre
Maccabi Table Tennis Club - Carmel Gym
Mandurah Aquatic & Recreation Centre
Melbourne Sports & Aquatics Centre
Mornington Peninsula Table Tennis Centre
Northern Territory Netball Stadium
ParkView Hotel
Scorpio Table Tennis Academy
Shepparton Sports Stadium
Silverdome
Sunbury Reserves Stadium
The Champions Room @MSAC
Traralgon Table Tennis Stadium
TTV Office (@MSAC)
Victoria Park, Daylesford
Warrnambool Table Tennis Stadium
Yarra Table Tennis Club
Yarrawonga Table Tennis Hall
How did the injury occur*
Please select...
Collision with fixed object
Collision with other person
Fall/stumble
Jumping
Landing from jump
Other
Overexertion
Overuse
Slip/trip
Struck by ball (e.g. dislocated finger)
Struck by other player
Temperature-related (e.g. heat stress)
Twisting to pass or accelerate
Description*
Injury details
Add an injury
Body part*
Select...
Head
Ear
Nose
Cheek
Mouth and Lips
Teeth
Jaw
Gums
Eye
Neck
Shoulder
Upper Arm
Elbow
Forearm
Wrist
Hand
Thumb
Index (2nd) Finger
Middle (3rd) Finger
Ring (4th) Finger
Pinky (5th) Finger
Chest (Thorax)
Abdomen
Pelvis
Hip
Thigh
Knee
Lower Leg
Ankle
Foot and Toes
Back
Side*
Select...
N/A
Left
Right
Tissue(s) affected
Skull
Scalp/hair
Skin
Soft tissues
Skin
Soft tissues
Skin
Soft tissues
Skin
Soft tissues
Temporomandibular joint
Bone
Fillings
Bone
Globe
Cornea
Eyelid
Orbit
Sclera
Cervical vertebrae
Muscles
Joint capsule and ligaments
Skin
Trachea
Oesophagus
Nerves
Blood vessels
Other
Gleno-humeral joint
Acromio-clavicular joint
Sterno-clavicular joint
Anterior soft tissues - joint capsule, tendons, ligaments
Posterior soft tissues - joint capsule, tendons, ligaments
Superior soft tissues
Inferior soft tissues
Skin
Blood vessels
Other
Anterior soft tissues
Posterior soft tissues
Skin
Blood vessels
Other
Radio-humeral joint
Ulnar-humeral joint
Proximal radio-ulnar joint
Medial soft tissues
Lateral soft tissues
Nerves
Skin
Blood vessels
Other
Radius
Ulna
Medial soft tissues
Lateral soft tissues
Skin
Blood vessels
Other
Distal radio-ulnar joint
Carpals and wrist joints
Soft tissues - ligaments, tendons
Nerves
Skin
Blood vessels
Other
Bones (metacarpals)
Joints (CMC, MCP)
Soft tissues - ligaments, tendons
Skin
Blood vessels
Other
Bones (Phalanges)
Joints (MCP, IP)
Soft tissues - ligaments, tendons
Skin
Blood vessels
Other
Bones (Phalanges)
Joints (MCP, IP)
Soft tissues - ligaments, tendons
Skin
Blood vessels
Other
Bones (Phalanges)
Joints (MCP, IP)
Soft tissues - ligaments, tendons
Skin
Blood vessels
Other
Bones (Phalanges)
Joints (MCP, IP)
Soft tissues - ligaments, tendons
Skin
Blood vessels
Other
Bones (Phalanges)
Joints (MCP, IP)
Soft tissues - ligaments, tendons
Skin
Blood vessels
Other
Thoracic vertebrae
Soft tissues - posterior muscles
Soft tissues - anterior/lateral muscles
Soft tissues - ligaments, tendons
Ribs
Internal organs (lungs, heart)
Sternum
Skin
Other
Internal organs (stomach, kidneys, spleen)
Muscles
Skin
Blood vessels
Other
Hip bones (ileac, pubic, sacral)
Buttock muscles
Groin muscles
Soft tissues - ligaments, tendons
Nerves
Skin
Blood vessels
Other
Hip (ilio-femoral) joint
Lateral hip muscles (TFL)
Anterior hip muscles (iliopsoas)
Blood vessels
Nerves
Other
Femur
Anterior muscles (quadriceps)
Posterior muscles (hamstrings)
Medial muscles (long adductors)
Skin
Blood vessels
Other
Tibio-femoral joint
Patello-femoral joint
Proximal tibio-fibular joint
Soft tissues - cartilage, meniscus
Soft tissues - ligaments, tendons, joint capsule
Blood vessels
Skin
Other
Tibia
Fibula
Anterior compartment muscles
Posterior compartment muscles
Skin
Blood vessels
Other
Talo-crural joint
Distal tibio-fibular joint
Soft tissues - ligaments, joint capsule
Soft tissues - posterior tendons (Achilles)
Soft tissues - anterior/lateral tendons
Blood vessels
Skin
Nerves
Other
Tarsal bones
Metatarsal bones
Phalanges
Soft tissues - plantar fascia, muscles
MTP joints (hallux valgus)
Soft tissues - ligaments, tendons
Skin
Blood vessels
Nerves
Other
Lumbar vertebrae
Soft tissues - posterior muscles
Soft tissues - ligaments and tendons
Skin
Other
Soft tissues
Nature of injury*
Select...
Abrasion, graze
Blisters
Bruise, contusion
Cardiac problem
Concussion
Dislocation, subluxation
Fracture, suspected fracture
Inflammation, swelling
Loss of consciousness
Open wound, laceration, cut
Other
Overuse injury to muscle
Respiratory problem
Sprain (e.g. ligament tear)
Strain (e.g. muscle tear)
Unspecified medical condition
Protective gear*
Select...
Box
Braces, guards, orthoses
Eye goggles
Face mask
Flotation device
Footwear
Gloves
Helmet
Helmet, mouthguard, wrist/elbow/knee pads
Mouthguard
None
Other
Padding
Splints
Taping
Thermal devices (e.g. thermoskin, wetsuit)
Vehicle restraints
Previous history of injury
Initial treatment*
Select...
CPR
Dressing
Manual therapy
Massage
None given - not required
None given - referred elsewhere
RICER
Sling/splint
Strapping/taping
Stretch/exercises
Submit report
