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Injury & Suspected Concussion Incident Report Form
What to Report: An incident that causes any player, manager, coach, umpire, volunteer or spectator to receive medical treatment and/or first aid must be reported to the league by the team coach through this online form within 48 hours of incident.

This includes even passive treatments such as the evaluation and diagnosis of the extent of the injury or periods of rest. For instance, if a player is out of action due to an arm injury please file a report.

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

Injured Person's Name: *
Your answer
What Sport? *
What Division?
What team is the injured associated with: *
Your answer
Incident Date: *
MM
/
DD
/
YYYY
Incident Time (Approximate): *
Time
:
Incident Location (Field): *
Injured Person's Role *
Incident occurred while participating in? *
Type of Injury: *
Your answer
Did the injured party suffer a suspected Concussion? *
Was First Aid Required? *
Was Emergency Aid to Field Required? *
If the parent/guardian has been contacted already, please list their name:
Your answer
Please give a short description of the incident: *
Your answer
Could this accident/injury have been avoided? If so, please describe how: *
Your answer
Name of person submitting this Report: *
Your answer
Role of person submitting this Report (Coach/Parent/Spectator etc): *
Your answer
Phone Number of Person Submitting Report: *
Your answer
Send Confirmation Email to: *
Your answer
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