Fossil Creek Little League Incident Report
Name of Person Submitting Report
*
Name of Person Submitting Report
Players Name
*
First Name
Last Name
Incident Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Incident Time
*
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
15
30
45
Minutes
AM
PM
AM/PM Option
Parent or Guardians Name
*
First Name
Last Name
Parent or Guardians Email
*
example@example.com
Parent or Guardians Phone Number
*
-
Area Code
Phone Number
Head Coach's Name
*
Team Division and Name
*
Practice Location (Name and or Address)
*
Enter name of school, church, park, etc...
Location of Injury
*
Hand, Arm, Head, etc...
Please Describe the Injury
*
What was the Player Doing When He/She was Injured?
*
Please give us as much detail as possible.
Was Any Treatment Given On Site?
*
No Treatment Required
Basic First Aid at the Field
Taken to the Doctor
Taken to the Hospital
Submit Report
Should be Empty: