Activities/Reporting

High Desert Little League Incident/Injury Tracking Report
Incident Date:
Field Name/Location*
Injured Persons Name*
Date of Birth*
Parent's Name (If Player)
Address
City, State and Zip
Phone Number:
Incident occurred while participating in:
Position/Role person(s) involved in:
Type of Injury:
Was first aid required

Yes (is yes what)No
Description of First aid if yes:
Was professional medical treatment required:

Yes (is yes what)No
Description of medical treatment if yes:
(If yes, the player must present a non-restrictive medical release to the league prior to being allowed in a game or practice.
What activity was being performed when incident occurred
Please give a short description of the incident:
Could this incident have been avoided? How?
Prepared by/Position with HDLL
Phone Number:
Date Prepared
Should be Empty:

High Desert Little League Incident/Injury Tracking Report