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Injury Report Form
Location
Stella #1
Stella #2
Stella #3
Calabrese #1
Calabrese #2
Calabrese #3
Calabrese #4
Other
Location (if "Other")
Injured Person's Name
Date of Birth
Sex
Male
Female
Address
Phone
Parent Name (if child)
Particulars of the Incident
Date
Time
Occurred During
Choose Option
Tryout
Practice
Game
Tournament
Travel To
Travel From
Other (specify in Additional Info section)
Role of Injured
Choose Option
Batter
Baserunner
Pitcher
Catcher
First Base
Second Base
Shortstop
Third Base
Left Field
Center Field
Right Field
Dugout
Manager/Coach
Umpire
Spectator
Volunteer
Describe the Injury Itself
Was First Aid Given?
No
Yes
If "Yes," What First Aid Was Given?
Was Professional Medical Treatment Required?
No
Yes
If "Yes" Then Describe
Player Injured Via
Choose Option
Basepath Running
Basepath Sliding
Hit By Ball - Pitched
Hit By Ball - Thrown
Hit By Ball - Batted
Collision With Player
Collision With Structure
Grounds Defect
Other (Specify Below)
Surrounding the Field?
Choose Option
Seating Area
Parking Area
Concession Area
Playground Area
Away From the Field?
Choose Option
Travel - Car
Travel - Bike
Travel - Walking
League Activity
Other (Specify Below)
Brief Description Of The Incident
Was This Incident Avoidable? How?
Additional Information
Reporting Person's Information
Report Prepared By
Position
Email Address
Your Phone
Today's Date
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Winslow Township Little League
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