East Central Illinois Football Officials Association

East Central Illinois Football Officials Association
Mattoon, IL 61938
jrick35@yahoo.com

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Medical Forms

Every time we step on the field we have every player’s safety and welfare in mind yet I know I’ve never taken the steps to ensure I’m cared for in an extreme medical situation.

So picture the potential scenario. During a varsity contest you find yourself, quite by accident, caught in a play and as a result, knocked unconscious. You are 60 miles away from home, in the back of an ambulance and on your way to a hospital that knows nothing about you. They have no contact information because your wallet/cell phone is in the locker room and your crew is back at the game. The risk that this situation occurs is low and I hope nothing like this ever happens but we need to be prepared if it does.

As we discussed in our association meeting, we think it would be a good practice to travel with the enclosed Officials Medical Form. Regardless of the contest level (JFL to Varsity) we should take a copy of this form to every game. The recommended procedure is:

  • Each official completes the form below. It has been recommended (RJ deserves the credit) that you include a copy of your company medical card and maybe your driver’s license. Those documents should then be sealed in a #10 security envelope with your name on the outside of the envelope.
  • Upon arrival at the game site, we will provide the site coordinator with our pack of envelopes and explain that should any official require medical attention, we will request that official’s envelope be given to the medical personal.
  • At the conclusion of the game, we will collect the envelopes from the site coordinator for reuse at another contest.

I created the form based on advice from the local hospital. This is certainly optional but even if you are not unconscious and require off site medical attention, it would be nice to have this information readily available.

Please don’t hesitate to contact with questions or improvement suggestions.

Have a safe season!

John Woodruff

Medical Form



Fill out and print this form to take with you to give to a Game Official or the chain gang at your games. Then if needed emergency response personnel will have your pertinent medical information.

Copyright 2010 East Central Illinois Football Officials Association. All rights reserved.

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East Central Illinois Football Officials Association
Mattoon, IL 61938
jrick35@yahoo.com