Youth Baseball On-Field Incident Report
Incident Details
Date of Incident
Time of Incident
Location (field, park, etc.)
Team(s) Involved
Game/Event Name or Number
Person(s) Involved
Name(s)
Role(s) (player, coach, umpire, spectator)
Team Affiliation
Incident Description
Describe what happened
Injury Information
Were there any injuries?
No
Yes
If yes, describe injuries
Was first aid/medical attention given?
No
Yes
If yes, by whom?
Witnesses
Name(s) of witness(es)
Contact information
Action Taken
Describe any immediate action taken
Report Filed By
Name
Role/Position
Date
Signature