California 54 Little League Injury Report 2021
If an injury/incident occurs, League safety officers have two options to report the information to the district:
          1. Provide injury information through this form by completing the items below, OR
          2. Send a copy of the ASAP Incident/Injury Tracking Report to the district safety officer
              (SafetyOfficer.CA.D54@gmail.com).
Thank you for assisting our district in its mission to enhance the safety of our players, volunteers and communities.
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Email *
Date of incident:
MM
/
DD
/
YYYY
Age of injured person:
Gender of injured person:
Clear selection
A.) Incident occurred while participating in:
B.) Incident occurred while participating in:
C.) Incident occurred while participating in:
Position/Role of person(s) involved in incident:
Type of injury:
Was first aid required?
Clear selection
If first aid was required, what:
Was professional medical treatment required?
Clear selection
If professional medical treatment was required, what:
Type of incident (A): On primary playing field
Type of Incident (B): Adjacent to playing field
Type of Incident (C): Concession Area
Type of Incident (D): Off Ball Field
Please give a short description of the incident:
Could this accident have been avoided? How?
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