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!
Sarah Preiss-Farzanegan, M.D., EDHLL Safety Officer

Email *

Your name (first and last) *

Your phone number (the Safety Officer will call you as mentioned above) *

Incident Date *

YYYY

Time the incident occurred (approximate time is ok) *

Time

Field name/location where incident occurred *

Brooks Tee Ball field

Deputy Jeff Mitchell field

Silva Valley

Oak Meadow East

Oak Meadow West (closest to Silva Valley Parkway)

NY Creek (aka CSD East)

CSD North (closest to dog park)

CSD South (closest to playground)

Bass Lake

Valley View

Snack Shack

Not applicable

Other:

Injured person is *

Child

Adult volunteer

Spectator

Other:

Injured person's name: *

Injured person’s phone number (parent/guardian if child): *

Brief description of injury (or near miss): *

Send me a copy of my responses.

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