INCIDENT REPORTING FORM          [Updated 05/14/2009 ]

 

Please complete this online version of Lakota Sports Organization Incident Form when you feel the Board needs to know about a certain incident within our organization.  There is an action plan in place and the completion of this form will begin that process

 

Please select sport:

 

Date of incident:  

 

Place of incident:

 

Your name:

 

Phone:   E-mail:

 

Are you a Coach Player Parent Referee/Umpire?

 

Did the injury require immediate medical attention?

Yes  No

Please provide details in the space below:

 

Was any other person involved and or injured?

Yes  No

Please provide details in the space below:

 

Was rain, lightning or any other field condition a factor in this incident?

Yes  No

Please provide details in the space below:

 

Had this or a similar type of incident happened to the parties involved in the past?

Yes  No

Please provide details in the space below:

 

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