Womens AIL Referee Concussion Reporting 2018/19 Question Title * 1. Referee Name Question Title * 2. Please insert the NAME and NUMBER of the player (If known) who sustained the suspected/confirmed concussion Question Title * 3. Please insert the club of the player (If known) who sustained the suspected/confirmed concussion Blackrock College RFC Highfield RFC Old Belvedere RFC UL Bohemian RFC Galwegians St Mary's College Cooke RFC Railway Union RFC Question Title * 4. Please insert the date the suspected/confirmed concussion occurred on? Question Title * 5. If known, what was the mechanism of the suspected/confirmed concussion Collapsed Maul Collapsed Scrum Collision with own player Collision with opposition player Collision with object e.g. posts, advertising Line-out Maul Presenting Ball Poaching Ball Ruck Tackled Tackling Scrum Unknown Other (please specify) Question Title * 6. Was the player immediately removed the player from the field of play? Yes No Question Title * 7. Was a doctor or physiotherapist present at the time of the suspected/confirmed concussion? Yes No Don't know Question Title * 8. Who removed the player from the field of play? Player Coach Referee Doctor Physiotherapist Other (please specify) Question Title * 9. Please add any other comments you may have. Done