MPSL Incident Report

Report Date: ____________________    Report Organization: __________________________

Report Type (Initial, Draft, Final, Status): ___________________________________________

Report Created By: ___________________   Title: ___________________________________

Contact Phone/Email: ____________________/______________________________________

Signature: _____________________________                      Date/Time: ________/__________

Section 1 – POC Information

Incident Reported By: __________________________                    Date/Time: ______________

Location: _________________           Email: ___________________    Phone: ______________

Signature: _____________________________________________________________________

Section 2 – Organizations/Persons Notified of Incident

(Name): __________________________________                          Date/Time: _______/_______

Phone/Email: ___________________/___________________________

(Name): ___________________________________                        Date/Time: _______/_______

Phone/Email: ________________/____________________________

(Name): ____________________________________                      Date/Time: ______/________

Phone/Email: ______________________/___________________________

Section 3 – Witnesses to the Incident

(Name): __________________________________                         Date/Time: _______/________

Phone/Email: ___________________/___________________________

(Name): __________________________________                         Date/Time: _______/________

Phone/Email: ________________/____________________________

(Name): ___________________________________                       Date/Time: ______/_________

Phone/Email: ______________________/___________________________

Section 4 – Incident Information

 Location: _____________________________________    Date/Time: _______/_______

Describe the Incident that Occurred (Detail what occurred, when/where/how/why did this happen, and who has been affected by the incident and what specific mitigation efforts are planned or have been completed):

When: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Where: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

How: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Why did this happen: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Who has been affected by the incident: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

What specific mitigation efforts are planned or have been completed: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Note: Send completed form to the MPSL President, MPSL Vice President, MPSL External Vice President, MPSL Commissioner, and MPSL Referee Assigner.

Examples on when to use this form (this is not an all-inclusive list):

• If a couch, manager, or player(s) have been physical or verbally attacked at a MPSL sanctioned event.
• If the field was not in a condition to play the game.
• If the opponent at a MPSL sanctioned event was not dressed in accordance with the MPSL By-Laws.
• If a couch, manager, or player have been racially attacked at a MPSL sanctioned event.
• If the referees did a bad job managing the MPSL sanctioned event.
• If your game report was missing an incident, that the referee did not address.
• If your opponent is playing players not in compliance with the MPSL By-Laws.