Injury Report Form

This form is intended to document any injuries that occur during Eastvale Girls Softball activities, including games, practices, clinics, or team events.

The information collected helps our league:

  • Ensure appropriate follow-up and care for injured players
  • Identify any safety concerns or patterns that may require attention
  • Maintain accurate records for insurance and liability purposes


This form should be completed by a coach, parent, umpire, or board member within 24 hours of the incident. Timely and detailed reporting is crucial in helping us keep all players safe.

 All comments are private and personal information will not be released to anyone beyond the EGSA Executive Board  and  Board of Directors.

 A League Representative will get back to you within 24 hours of this form being received.

Player's Full Name
Date of Birth
RadDatePicker
RadDatePicker
Open the calendar popup.
Team Name & Division
Team and Division you/your player(s) are on
Parent/Guardian Name
First & Last Name of Parent/Guardian of Player
Parent/Guardian Email
Email of Guardian of Player
Parent/Guardian Phone Number
Parent/Guardian's Phone Number
Date of Injury
RadDatePicker
RadDatePicker
Open the calendar popup.
Date the injury occurred
Time of Injury
At what time did the injury occur?
Location of Indicient
Field/Number, dugout, etc.
Type of Activity
Game, practice, warm-up, etc.
Weather/Field Conditions
At the time of the injury, what were the playing conditions like?
Cause of Injury
Please be as specific possible when describing what happened that lead to the injury.
Injury Description
Please be as specific as possible when describing the injury.
First Aid Administrered
If Yes, by Whom?
The person who administered the first aid
Was the player removed from play?
Was 911 called?
Was the player taken to the hospital?
If Yes, where?
Were there any witnesses?
If yes, list names/contact info if available
Name
Name of person completing this form
Role
Coach, Board Member, Parent, etc.
Phone Number
Email
Signature
I confirm that the information provided in this report is accurate and complete.
Date of Submission
RadDatePicker
RadDatePicker
Open the calendar popup.
Verification

Required Fields