Injury & Suspected Concussion Incident Report Form (Bradford Minor Baseball Association)

Injury & Suspected Concussion Incident Report Form

What to Report: Any incident that causes any player, manager, coach, umpire, volunteer or spectator to receive medical treatment and/or first aid must be reported to BMBA by the team coach through this online form within 48 hours of incident. This includes even passive treatments such as the evaluation and diagnosis of the extent of the injury or periods of rest. For instance, if a player is out of action due to an arm injury please file a report.

Incident Details

This form is for Bradford Minor Baseball Association (BMBA) purposes only, to report safety hazards, unsafe practices and/or to contribute positive ideas in order to improve league safety. For all injuries which could become insurance claims, please fill out and turn in the official Sport Accident Claim Forms available from the association's vice-president. All personal injuries should be reported to BMBA as soon as possible.

Injured Person's Name:^*

Division:^*

What team is the injured associated with:^*

(type "none" if applicable)

Incident Date:^*

Incident Time (Approximate):^*

Incident Location (Field):^*

Injured Person's Role:^*

Incident occurred while participating in?^*

Type of Injury:^*

(just a quick description please)

Did the injured party suffer a suspected Concussion?^*

Was First Aid Required?

Was Emergency Aid to the Field Required?

If the parent/guardian has been contacted already, please type their name:

Please give a short description of the incident:^*

Could this accident/injury have been avoided? If so, please describe how:

Name of person submitting this Report:^*

Role of person submitting this Report (Coach/Parent/Spectator etc):^*

Send Confirmation Email to:^*

Example: [email protected]. Your submission will be sent to this address.

Injury & Suspected Concussion Incident Report Form (Bradford Minor Baseball Association)

Incident Details

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