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TCLL Injury Report
Form to report injuries that happen either home or away. The email address field (first field) is for the coach's email address. If there is a Near Miss issue (field issue), please report this on a different form.
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* Indicates required question
Email
*
Your email
Date of Incident:
*
MM
/
DD
/
YYYY
Field Name/Location
*
Your answer
Injured Person's Name
*
Your answer
Age
*
Choose
7
8
9
10
11
12
13
14
15
16
Other
Sex
*
Male
Female
Parent's Name
*
Your answer
Parent's Email Address
*
Your answer
Parent's Phone Number
*
Your answer
Incident Occurred during:
*
League Game
Practice
Type of incident and location:
*
On Primary Playing field
Adjacent to Playing field
Concession Area
Off Ball Field
Position/Role
*
Batter
Third Base
Baserunner
Short Stop
Pitcher
LField
Catcher
CField
First Base
RField
Second Base
Dugout
Coach/Mgr.
Volunteer
Other
Type of Injury (sprained ankle, jammed finger etc.)
*
Your answer
Please give short description of Incident
*
Your answer
Was First Aid Required?
*
Yes
No
Was Professional Medical Treatment Required?
*
Yes
No
Prepared by:
*
Your answer
Send me a copy of my responses.
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