Injury Tracking Report
This form is for Upper Ottawa Valley Little League use. It is used to evaluate potential safety hazards, unsafe practices and/or to contribute positive ideas in order to improve league safety. Please ensure this is filled out within 24 hours of an incident.
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Person Reporting *
Email Address *
Team Name
What level was this at? *
Where did the injury occur? *
Did the incident occur during: *
Field Name *
Person's name involved in injury *
Date of birth
MM
/
DD
/
YYYY
Contact information if not member of our league
Parent's name (if player involved)
Incident Date *
MM
/
DD
/
YYYY
Incident time *
Time
:
Position/Role of person involved in the incident *
If a player, what position was the player?
Clear selection
Describe injury *
Was first aid required? *
If yes describe treatment
Did patient require professional medical treatment? *
If yes provide details
If this occurred on field of play was it *
Give a description of the incident *
Could this accident have been avoided? *
Submit
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