2025 D2 Injury / Incident Tracking Form
Thank you for completing this form, which will assist us respond to incidents, provide support, evaluate our safety program, and make positive improvements for all participants.  

Please provide as much detail as possible, using ONE FORM FOR EACH INJURED PERSON. Forms must be completed and submitted by either a PLAYER, COACH, MANAGER, TEAM VOLUNTEER, UMPIRE or bystander within 24 hours of an injury.

START with the email of the person completing this report, which should be either a coach, manager, umpire, or responsible adult volunteer who is aware of the details of the incident.

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Email *
Q1: Please choose the correct baseball season for this report. (select one) *
Required
Q2: Date of injury? *
MM
/
DD
/
YYYY
Q3: Time of injury? *
Time
:
Q4: Location of the incident (specific name of facility, field, diamond #, etc): *
Required
Q5: Report writer's FIRST name. *
Q6: Report writer's LAST name. *
Q7: Report writer's cell phone number (ie: 780-123-4567). *
Q8: Report writer's position in Little League? *
Required
Q9: What age division are you referring to for this report? (select one) *
Required
Q10: What league is the injured person registered with? (select one) *
Required
Q11: FIRST name of injured person. *
Q12: LAST name of injured person. *
Q13: BIRTH DATE of injured person (if known)
MM
/
DD
/
YYYY
Q14: ADDRESS of injured person (if known) - including city, province, postal code.
Q15: PHONE number(s) of injured person - cell, home (ie: 780-123-4567).
Q16: Parent's FIRST name (if injured person is a minor).
Q17: Parent's LAST name (if injured person is a minor).
Q18: Parent's PHONE number(s) - cell, home (ie: 780-123-4567).
Q19: The incident occurred while participating in which ACTIVITY? (select one) *
Required
Q20: Injured person's ROLE at the time of the incident: (select one) *
Required
Q21: MECHANISM of injury: (how it happened) *
Required
Q22: Specific PLACE the incident took place. (select one) *
Required
Q23: Full details regarding the cause, nature, type of injury, and seriousness. *
Q24: First Aid required / provided? (select one) *
Required
Q25: Professional Medical Treatment required / provided?  *If yes the player must present a non-restrictive medical release prior to being allowed in a game or practice. (select one) *
Required
Q26: Suspected CONCUSSION?  *If yes then the injured person must be removed from ALL activity and participate in concussion evaluation, treatment and recovery protocol, BEFORE returning to play. (select one) *
Required
Q27: What could have PREVENTED the incident? *
Q28: Additional Comments:
PRIVACY STATEMENT: The personal information on this form is strictly confidential and collected for the purposes of Little League District 2 safety program pertaining specifically to injury/incident reporting, response, support, evaluation and prevention. The information is collected, retained and distributed in accordance with the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection or use of your personal information, please contact your respective Little League President which is posted at www.edmontonlittleleague.ca .
A copy of your responses will be emailed to the address you provided.
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