Mississippi Little League Incident Reporting Tool
This form is intended for the use of Mississippi Little League only. It is used to evaluate potential safety hazards, unsafe practices and opportunities to evaluate and improve League safety. Please ensure this is filled out within 24 hours of an incident.  Any questions or concerns can be directed to the League Safety Officer.
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Email *
Name of the Individual Reporting the Incident *
Date and Time of Incident *
MM
/
DD
/
YYYY
Time
:
Injured Person's Name and/or Names Individuals Involved *
Location of Incident (Field Name if Applicable) *
Contact information if individual is not a member of the MLL
Incident Occurred During  *
Team Name *
Division *
Position/Role of Person(s) Involved (select all that apply)
If First Aid was required, please describe type of first aid administered or supplies used
Please describe the Incident *
If the incident occurred on the field of play, please indicate the type of incident below *
Could this incident have been avoided?  If so, how? *
Was professional medical treatment required? *
If further medical treatment was required, please describe
Further comments (if required)
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