SCAA Safety Incident/Injury Tracking Form
SCAA requires that we have written documentation of any injuries/accidents sustained either at the SCAA Complex (by players, coaches, spectators, vendors, etc.) or while a registered SCAA Player or Coach is representing the organization as a rostered member of an SCAA team at an SCAA sanctioned event.   This is required for insurance purposes and will keep the Board of Directors informed of any injuries/incidents.  it will also aid SCAA in the development of further safety measures to protect membership and property.
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Email *
Name of Person Filling Out This Report: *
Date of Incident/Injury: *
MM
/
DD
/
YYYY
Time of Incident/Injury: *
Time
:
Field Name/Location Incident/Injury Occurred At: *
Injured Person's Name: *
Injured Person's Date of Birth: *
MM
/
DD
/
YYYY
Parent's Name (if minor): *
Injured Person's Address: *
Injured Person's Phone: *
Injured Person's Sex (M/F): *
League Incident Occurred In While Participating In: *
Division Incident Occurred In: *
Type of Event Incident Occurred In: *
Position/Role of Injured Person: *
Required
Describe Incident/Injury: *
Was First Aid Required? *
Was Professional Medical Treatment (Hospital/ER/Urgent Car/Doctor's Office) Required?  (If yes, a non-restricted medical release must be presented for player to return to games/practices/events.) *
What City Services/Authorities Responded to Incident (if any)? *
Did Incident/Injury Occur on Playing Field?  If so, check where: *
Required
Did Incident/Injury Occur Off Field?  If Yes, Check Location: *
Give Short Description of How Incident/Injury Occurred: *
Could This Incident Have Been Avoided? *
SCAA requires this form so that we have written full documentation of any injuries/accidents sustained either at the SCAA Complex (by players, coaches, spectators, vendors, etc.) or while a registered SCAA Player or Coach is representing the organization as a rostered member of an SCAA team at an SCAA sanctioned event.   This is required for insurance liability/possible litigation purposes and will keep the Board of Directors informed of any injuries/incidents.  It will also aid SCAA in the development of further safety measures to protect membership and property.  By clicking below, you acknowledge this is form is complete and truthful to the best of your knowledge. *
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