WLL Injury Reporting Form

This form is for Little League purposes only, to report safety hazards, unsafe practices and/or to contribute positive ideas in order to improve league safety.

When an accident occurs, obtain as much information as possible.

SAFETY OFFICER: For all claims or injuries which could become claims, please fill out and turn in the official Little League Baseball Accident Notification Form available from your league president and send to Little League Headquarters in Williamsport (Attention: Dan Kirby, Risk Management Department). Also, provide your District Safety Officer with a copy for District files.

 

Scan QR code below for access to

the

Woodcreek Little League

INJURY Report Form:

 

Date/Time of Injury
Field Name/Location
Name of Injured
Position/Role of Injured
select
Player, Jr. Worker or Jr. Umpire Age
Division
select
What division is the player in?
Team Name
Enter N/A for Jr. Workers or Jr. Umpires
Manager Name
Enter N/A for Jr. Workers or Jr. Umpires
*Players Only* Parent Name/Names
*Players Only* Parent Phone Number
*Players Only* Parent E-mail
INJURY
Give a description of the Injury please include what the player was doing at the time.
First Aid
Was First Aid Required/ Please give a brief description of what type.
Medical Attention
select
Was Professional Medical Treatment Required?
YES?
If yes, what treatment was preformed?
Prepared By?
Who is filling out this form?
Position
What is your position with WLL?
Preparer's Phone #
Required Fields