World Arm Wrestling Federation

Injury Report

Tournament Name Tournament Date
Tournament Location Tournament Director
Type of Tournament
Local [ ]      Sanction [ ]      Circuit [ ]      Provincial / State [ ]      Nationals[ ]    International / Worlds [ ]
Injured Person 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:
Email: Phone:
Name of Second Referee: Level:
Email: Phone:


Name:(please print)