Canadian Arm Wrestling Federation

Injury Report

Tournament Name Tournament Date
Tournament Location Tournament Director

Type of Tournament

Local [ ]      Prov. Sanction [ ]      CAWF Circuit [ ]      Provincials [ ]      Nationals/International [ ]

Injured Person Report

Name Phone:
Sex Weight Age Years Arm Wrestling

Were the rules including "Dangerous Positions" demonstrated before the competition?    yes    no
Was this person in a dangerous position immediately prior to the injury?    yes    no
Was medical attention administered on-site?    yes    no By Who?
Did they go to a hospital/medical facility?    yes    no
How did they get there? Friend Ambulance Other
Was the arm broken and if so where?   yes    no

Was anyone videotaping?   yes    no Name: Phone:
Name of Head Referee: Level: Phone:
Name of Second Referee: Level: Phone:

Name:(please print)