CA District 54 Injury Reporting
League safety officers, please use this form to report injuries to the district.
(Option: OR send copy of Little League Incident/Injury Tracking form to SafetyOfficer.CA.D54@gmail.com)

This information will be analyzed (and de-identified when applicable) for injury trends that can be addressed with education and/or injury prevention efforts, and discussed with league presidents at the monthly president's meeting.

Thank you for assisting District 54 in our mission to keep our players, volunteers and communities safe.

Sarah Preiss-Farzanegan, M.D.
CA District 54 Little League, Safety ADA
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Email *
Date of incident *
MM
/
DD
/
YYYY
Person involved is a/an: *
If child involved, please state their age:
Brief description of incident/injury: *
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