Capitol Hill Little League Incident & Injury Tracking Report
If a player has an accident or suffers an injury during a game or practice, coaches should determine whether medical attention beyond basic first aid is required. If so, the manager should allow the player to leave with his/her parents to seek medical attention or, in serious cases, call 911 for EMS services.
If a player is removed from a game, practice, or CHLL event due to injury, managers/coaches must fill out this injury/accident tracking form within 24-48 hours.
Name of adult submitting report
Contact phone number of adult submitting report
Injured person's name
Injured person's age
Parent's Name (If known and injured is Player)
Parent's Contact Information (If known and injured is Player)
Incident occurred while participating in the following activity
What field or loaction did the incident/injury occur
Incident occurred during
Position/Role of injured person
Type of incident and location
On the base paths (running)
On the base paths (sliding)
Hit by ball (pitched)
Hit by ball (thrown)
Hit by ball (batted)
Collision with player
Collision with structure
Adjacent to Playing Field (Seating Area/Parking Area/Concessions/Other)
Off Ballfield (Travel/League Activity)
Was first aid required?
If yes, what first aid was given
Was professional medical treatment requested?
If yes, who provided medical treatment
Provide a description of the incident
This form is for Capitol Hill Little League purposes only.
For all Accident claims or injuries that could become claims to any eligible participant under the Little League Accident Insurance policy, please complete the Accident Notification Claim form and send to Little League International.
For all other claims to non-eligible participants under the Accident policy or claims that may result in litigation, please fill out the General Liability Claim form and send to Little League International and Capitol Hill Little League.
A copy of your responses will be emailed to the address you provided.
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This form was created inside of Capitol Hill Little League.