SAFETY REPORT - Reporting an injury incident...
| Request to: | |
| Reporting manager/coach: | |
| Team Name: | |
| Phone# | |
| Email address: | |
| Name of player: | |
| Date of Incident: | |
| Where did it happen: | |
| Describe Injury in detail: | |
| Describe type of treatment: | |
| Was a parent or guardian present: | |
| Was any equipment provided by the league involved: | |
| Was the injured player seen by a medical professional: | |
How could this accident have been prevented |
|
| Electronic Signature Act: | |
| Safety Officer Use Only | |