EDHLL Injury Reporting Form

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Managers, to report an injury (or near miss), please complete the short form below.
The Safety Officer will contact the player's parent/guardian or the adult involved, complete the injury tracking form, determine if further action is needed (such as quarantine in the case of COVID-19, physician's note for return to play, etc.) and communicate the results of this conversation back to you.
Thank you for helping EDHLL continue to prioritize the safety of our players, volunteers and community!
Darin A. Trier, M.D., EDHLL Safety Officer

Email *

Reporting person's name (first and last): *

Reporting person's phone number (the Safety Officer will contact you as mentioned above): *

Incident date: *

YYYY

Time incident occurred (approximate time is fine): *

Time

Field name / Location where incident occurred: *

The involved person is a(n): *

Child

Adult volunteer (includes coaches)

Spectator

Other:

Name of person involved (first and last): *

Phone number of person involved (parent/guardian for a minor): *

Brief description of incident, injury, or near miss: *

Send me a copy of my responses.

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