Fairfax Little League: Injury Reporting

The following reporting procedures should be used by all managers, coaches, parents, umpires, and volunteers concerning injuries.

What to report - An incident that causes any player, manager, coach, umpire, or volunteer to receive medical treatment and/or first aid must be reported to the Director of Safety. The terms "medical treatment and/or first aid" should include even passive treatments such as the evaluation and diagnosis of the extent of the injury. Any incident that (a) causes a player to miss any practice or game time; or (b) any event that has the potential to require medical assistance must be reported promptly.

When to report - All such incidents described above must be reported to the Director of Safety within 48 hours of the incident.

The Director of Safety is S. Roger Parthasarathy, M.D., and can be reached at the following: (Cell) 703-981-4556 (Work) 703-385-3333 Email: rogerpart@yahoo.com

How to make the report - Reporting incidents should be done using the form at the end of this page.

Director of Safety's Responsibilities - Within 48 hours of receiving the incident report, the Director of Safety will contact the injured party or the party's parents and (1) verify the information received; (2) obtain any other information deemed necessary; (3) check on the status of the injured party; and (4) in the event that the injured party required other medical treatment (i.e., Emergency Room visit, doctor's visit, etc.) will advise the parent or guardian of the Fairfax Little League's insurance coverages and the provisions for submitting any claims for reimbursement.

If the extent of the injuries are more than minor in nature, the Director of Safety shall periodically call the injured party to (1) check on the status of any injuries, and (2) to check if any other assistance is necessary in areas such as submission of insurance forms, etc. until such time as the incident is considered "closed" (i.e., no further claims are expected and/or the individual is participating in the league again).





Injured Person's Background Information
Name: DOB: Male Female
Parents: Age:
Address: Home Ph:
City/St/Zip: Work Ph:


Injury Information
Date of Incident: Description:
Time of Incident:
Location/field of Incident:
Was first aid required? Yes No
If yes, explain what was done?
 Were medical professionals required? Yes No
If yes, explain what was done?


Supplemental Information:

LeagueDivisionTeam InfoInjured Person was a:Injury Occurred during:
Team Name:

Manager's Name:


Position When InjuredType of Injury:Part of Body Injured:Cause of Injury:






Please provide the following information:

Reporter Information
Name:
Phone:
Email: