Player Safety Incident Report Form
Report and document player safety incidents accurately. Please complete all fields for a thorough incident review.
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident
*
Names of Individuals Involved (Players, Staff, Witnesses)
*
Type of Incident
*
Please Select
Injury
Unsafe Behavior
Equipment Failure
Facility Issue
Other
Describe What Happened
*
Severity of Incident
*
Minor
Moderate
Severe
Actions Taken (First Aid, Notifications, etc.)
*
Was Emergency Assistance Required?
*
Yes
No
Your Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Submit Report
Should be Empty: