Injury Report (Paris Youth Softball)

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Injury Report

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Injury Report

Please fill out this form for any injury that requires use of medical supplies or medical attention.

Reporter Information

Reporter Name^*

Required

Reporting Date^*

Required

General Information

Name of Injured Person^*

Required

First and Last Name

Name of Parent/Guardian

If known

Date and Time of Incident^*

Required

Division^*

Required

(LTP, U10, etc.)

Team Name^*

Required

Select, LL1, Green, etc.

Head Coach

Injury Specifics

Person Injured^*

Coach
Player
Spectator
Umpire
Volunteer

Required

Type of Activity^*

Clinic
Game
Practice
Tournament
Travel to/from Game
Tryout

Required

Select One

Position When Injured^*

Required

Type of Injury^*

Abrasion
Bite
Bruise
Concussion
Cut
Dental
Dislocation
Fracture
Heat Induced
Puncture
Sprain
Strain

Select as many as apply

Injury Location^*

Abdomen
Ankle
Arm
Back
Chest
Elbow
Face
Finger
Foot
Groin
Hand
Head
Leg
Neck
Shoulder
Wrist

Select as many as apply

Cause of Injury^*

Batted Ball
Batting
Catching
Colliding with Fence
Collision
Falling
Hit by Ball
Horseplay
Pitched Ball
Running/Sliding
Sharp Object
Tagging
Throwing
Thrown Ball

Required

Select One

Additional Details

Add more detail if required

Medical Treatment

What Medical Treatment Was Given?^*

Required

Was Ambulance Required?^*

NoYes

Required

Was Player Transported to Hospital?^*

NoYes

Required

Witness

Is there any witness to the injury that can be contacted if necessary for follow-up?

Witness Name(s) and contact info if available

Additional Comments

Describe any other relevant details about the incident.

Any Other Information?

Follow-Up

Have the parents/guardians been notified of the injury?

Yes
No
Not Applicable - Subject is not a minor

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