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.
* Required
Email address
*
Your email
Name of adult submitting report
*
Your answer
Contact phone number of adult submitting report
*
Your answer
Incident/Injury Date
*
MM
/
DD
/
YYYY
Injured person's name
*
Your answer
Injured person's age
*
Your answer
Parent's Name (If known and injured is Player)
Your answer
Parent's Contact Information (If known and injured is Player)
Your answer
Incident occurred while participating in the following activity
*
Choose
Baseball
Softball
Challenger
Division
*
Choose
A
AA
AAA
Majors
Juniors
Challenger
What field or loaction did the incident/injury occur
*
Your answer
Incident occurred during
*
Choose
Practice
Game
Workout
Clinic
Tournament
Special Event
Position/Role of injured person
*
Choose
Batter
Base Runner
Pitcher
Catcher
First Base
Second Base
Short Stop
Third Base
Outfileder
Dugout
Manager/Coach
Umpire
Volunteer
Spectator
Bystander
Type of incident and location
*
Choose
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
Ground Defect
Adjacent to Playing Field (Seating Area/Parking Area/Concessions/Other)
Off Ballfield (Travel/League Activity)
Was first aid required?
*
Choose
Yes
No
If yes, what first aid was given
Your answer
Was professional medical treatment requested?
*
Choose
Yes
No
If yes, who provided medical treatment
Your answer
Provide a description of the incident
*
Your answer
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.
ACCIDENT FORM:
https://www.littleleague.org/downloads/accident-claim-form/
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.
LIABILITY FORM:
https://www.littleleague.org/downloads/general-liability-claim-form/
A copy of your responses will be emailed to the address you provided.
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