INJURY DURING A GAME

• DO NOT PICK UP OR MOVE THE CHILD

• LET THE CHILD STAND UP AND LEAVE THE FIELD OF PLAY UNDER THEIR OWN POWER

• HAVE THE OTHER PLAYERS MOVE AWAY

• IF THE PLAYER IS SERIOUSLY

INJURED, SEND A PARENT TO

THE REFEREE TABLE SO HELP

CAN BE SUMMONED

• DO NOT ADMINISTER FIRST AID UNLESS YOU ARE TRAINED AND QUALIFIED

• FOLLOW UP ON SIGNIFICANT INJURIES WITH A PHONE CALL TO THE FAMILY

• REPORT TO THE LEAGUE BOARD THE DETAILS OF THE SITUATION

Guilderland Youth Soccer Incident Report

Date of Incident: Location:

Time of Incident: Specific Location(FieId #):

Address:

Party~es) Involved:

Name:

Full Address:

Phone:

1’eam Information

Coach:

Team #:

Nature and Description of Incident

Provide a brief, factual description of the incident.

Describe what the person was doing at the time of the incident.

How the incident occurred, object or substance involved, and the part (s) of the body affected.

Witnesses to the Incident -- List persons who were witness to the incident.

Was person seen by EMT?: (check one) Yes No If yes, date and time:

EMI’s Findings:

Was person seen by a provider?: (check one) Yes No LII If yes, date and time of visit:

Provider(s) name(s):

Provider’s Findings:

Was person sent to an ER or Hospital? (check one) Yes No

If yes, name and address:

Diagnosis / Course of action:

Form prepared by: Signature:

PLAYER INJURIES

INJURY DURING PRACTICE

• DO NOT LEAVE YOUR OTHER

PLAYERS TO CALL FOR HELP OR

TRANSPORT THE INJURED

PLAYER

• ASK A PARENT AT THE PRACTICE TO SUMMON HELP IF YOU DON’T HAVE A PHONE WITH YOU

• DO NOT ADMINISTER FIRST AID UNLESS YOU ARE TRAINED AND QUALIFIED

• DO NOT CARRY OR MOVE THE PLAYER. LET THE CHILD STAND UP UNDER THEIR OWN POWER

• FOLLOW UP ON SIGNIFICANT INJURIES WITH A PHONE CALL TO THE FAMILY

• REPORT TO THE LEAGUE BOARD ANY SERIOUS INJURY.

DOCUMENT THE SITUATION