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VAFC Incident Report

To be completed in the event of a serious injury or any other event. This should be completed AFTER any players have been safely taken care of. The Incident Report is to be submitted within 24 hours of the incident so the facts and details are clear.

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Type of Incident *
Required
Full Name (Person Submitting Report) *
Role (Person Submitting Report) *
Required
Email (Person Submitting Report) *
Phone (Person Submitting Report) *
Team (Name/Gender/Age Level) *
Location Incident Occured *
Date Incident Occurred *
MM
/
DD
/
YYYY
Approximate Time Incident Occurred *
Time
:
Full Names of the Parents/Players/Coaches/Officials Involved *
Description of the Incident (keep to facts as much as possible) *
Description of Injuries (If Applicable)
What action was taken on the field and by whom?
Was this incident reported to Club Staff (outside of this form)? *
If this was reported to Club Staff, who was it reported to?
Any other details or information?
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