This page contains the injury reporting form for the 2010 season.  In the event there is an injury please copy the following text below and fill out as much information as possible.  Please send the form to NNLL Safety Officer Ray Bangle via email.  His address is ray.bangle@nnll.org .

Instructions: Please complete as much information as possible. If unknown, leave blank.
 
Date/time of injury:
Field Name/Location:
Injured person's name:
Date of Birth:
Age:
Sex:
Injured person's address:
Parent's name (if player):
Work phone:
Home phone:
Parent's address (if different from player):
Incident occurred while participating in what league?
Position/role of person involved in incident (base, position, location on field):
Type of injury (i.e. cut arm, bruised leg, broken foot):
Was first aid required? If so, what was done?
Was professional medical treatment required? If yes, what:
Give short description of what happened:
Could this have been prevented? How:
Reported by:
Phone number:
Date:

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