Boerne Little League Incident/Injury Tracking Report

Boerne Little League Incident/Injury Tracking Report
League Name
League ID
Incident Date

MonthDayYear
Date
Field Name/Location
Incident Time
Injured Person’s Name
Date of Birth

MonthDayYear
Date
League Age
Sex

MaleFemale
Address
Parent's Name (IF Player)
Incident occurred while participating in:
Program:

BaseballSoftball
Division

T-BallMinorMajorIntermediateJuniorsSeniors
What type of Event?

TryoutPracticeGameTournamentSpecial EventTravel toTravel fromOther
Position/Role of person(s) involved in incident

BatterBaserunnerPitcherCatcherFirst BaseSecondThirdShort StopLeft FieldCenter FieldRight FieldDugoutUmpireCoach/ManagerSpectatorVolunteerOther
Type of injury
Was first aid required?

YesNo
If yes to previous question, what type of first aid required?
Was professional medical treatment required?

YesNo
If yes to previous question, what type of medical treatment required?
(If yes, the player must present a non-restrictive medical release prior to to being allowed in a game or practice)
(If yes, the player must present a non-restrictive medical release prior to to being allowed in a game or practice)

Type of incident and location:
On Primary Playing Field

Base Path:Running orSlidingHit by Ball:Pitched orThrown orBattedCollision with:Player orStructureGrounds DefectOther
Adjacent to Playing Field:

Seating AreaParking Area
Concession Area

Volunteer WorkerCustomer/Bystander
Off Ball Field

Travel:Car orBike orWalkingLeague ActivityOther
Please give a short description of incident
Please give a short description of incident
Could this accident have been avoided? How
Prepared By/Position
Phone Number
Date

MonthDayYear
Date
Signature

Clear
Should be Empty: