Accident Report Form

UpdatedFriday December 7, 2018 byNorth Arlington Little League.

An incident that causes any player, manager, coach, umpire or volunteer to receive medical treatment and/or first aid must be reported to the Safety Officer.  This includes even passive treatments such as the evaluation and diagnosis of the extent of the injury or periods of rest.

The Official Little League form can be found on the Little League website at:
Accident Claim Form
Accident Claim Form Instructions
Accident Claim Form Instructions (Spanish)

All such incidents described above must be reported to the North Arlington Little League Safety Officer within 24-48 hours of the incident.

Reporting incidents can come in a variety of forms.  Most typically, they are telephone conversations.  At a minimum, the following information must be provided.

  • The name and phone number of the individual involved.
  • The date, time and location of the incident.
  • As detailed a description of the incident as possible.
  • The preliminary estimation of the extent of any injuries.
  • The name and phone number of the person reporting the incident.