2014 Western Little League Safety Manual ASAP www.GRWESTERNLL.COM
2014 Western Little League Safety Manual www.GRWESTERNLL.COM ASAP 2014 WESTERN LITTLE LEAGUE SAFETY MANUAL – TABLE OF CONTENTS League & Emergency Contacts ............................................................................ 2 Safety Program Details ......................................................................................... 3 Severe Weather Policy .......................................................................................... 4 Concession Stand Information .............................................................................. 5 Local Rules ........................................................................................................... 6 Appendices A. Child First Aid/CPR/AED Reference (American Red Cross) ....................... 9 B. Adult First Aid/CPR/AED Reference (American Red Cross) ..................... 21 C. Volunteer Applications .............................................................................. 33 D. Accident Claim Form Instructions ............................................................. 35 E. Accident Claim Form ................................................................................. 37 F. Injury Tracking Form .................................................................................. 39 www.GRWESTERNLL.com 2014 WESTERN LITTLE LEAGUE SAFETY MANUAL – LEAGUE & EMERGENCY CONTACTS Western Little League P.O. Box 140731 Grand Rapids, MI 49514 2014 League Officers President: Rob Stellini 616.366.8654 stellinirob@gmail.com 2121 Cider Mill Trail, Walker MI 49534 Safety Officer: Alan Plum 616.648.4972 alandplum@gmail.com 703 Larkspur Ave NW, Grand Rapids MI 49504 Player Agent: Jim Buchanan 616.821.4094 buch19@iserv.net Treasurer Joe Tuttle 616.299.3156 joetuttle@qualitymodel.com Secretary: Sharon Kailing 616.460.8391 thekailing4@sbcglobal.net Information Officer: Adam Zavislak 616.485.8224 adamzavislak@yahoo.com Field Manager: Justin Miller 616.901.8479 miller5cto@att.net Equipment Mgrs: John Onderko 616.735.2319 johnonderko@hotmail.com Joe Ricord 616.648.3294 jricord@industrialems.com Concessions Mgr: Sabra Szczepaniak 616.589.4948 sabrapta@yahoo.com Sponsors/Uniforms: Mike Velzen 616.901.4608 velzenm@sbcglobal.net Umpire in Chief: Jeff Tuttle 616.813.3127 jefftuttle@qualitymodel.com Coaching Coordinator: Troy Clinger 616.291.6981 troyc@kentcompanies.com 2014 League Vice-Presidents Boys JR/SR: Roger Sweedyk Boys Majors: Alan Plum Boys Minors Bill Krall Coach Pitch Justin Miller Teeball: Jason Carlson Mushball: Jeff Barrett Softball Jr/Sr: Softball Min/Maj: Bob Wynsma Brad VanManen Joe Pietrusza 616.295.8505 616.648.4972 616.890.8318 616.901.8479 616.719.9329 616.822.6374 rrsweedyk@aol.com alandplum@gmail.com wrkrall@comcast.net miller5cto@att.net jcarlson@walkertool.com jeffbarrett@jmfg.com 616.893.2804 616.915.3678 616.238.1733 bwynsma@aol.com bradv@vanmanen.com joep51977@yahoo.com EMERGENCY NUMBERS Fire and Medical Grand Rapids Police (non-emergency) DIAL 911 616-456-3400 AMBULANCE SERVICE Life EMS (616) 458-LIFE (5433) 888-LifeEMS (888-543-3367) American Medical Response (AMR) Main: (616) 459-8228 Dispatch: (616) 459-8197 2014 FIELD LOCATIONS SHAWMUT HILLS ELEMENTARY SCHOOL 2550 Burritt NW, Grand Rapids MI 49504 Mushball, T-Ball, Coach Pitch, Minors & Majors KENOWA HILLS HIGH SCHOOL 3825 Herndershot NW, Grand Rapids MI 49544 Girl’s Softball (All Divisions) Juniors & Seniors (Baseball) www.GRWESTERNLL.com 2 2014 WESTERN LITTLE LEAGUE SAFETY MANUAL – SAFETY PROGRAM DETAILS 1) This plan and the Annual Little League Facility Survey will be submitted to Little League International as prepared by 2014 Western Little League (WLL) Safety Officer Alan Plum, who will be registered with Little League International. 2) Western Little League will distribute a copy of this Safety Manual to all Coaches, League Volunteers and the District Administrator. It will also be made available via the League’s official website: www.GRWESTERNLL.COM 3) A copy of the 2014 WLL Safety Manual will also be available in the WLL Concession Stand for anyone who wishes to review it. Subsequently, a meeting will be held prior to the start of the season with concessions workers to review proper food handling procedures and safety measures. 4) All WLL Coaches/Volunteers are required to submit the Official 2014 Little League Volunteer Application (see appendix) along with a valid government issued photo identification. All Coaches and Registered Volunteers will be subject to background checks. 5) Prior to the start of the season, WLL will attempt to make first aid and/or CPR training available to all Coaches. If possible, this will include AED (automatic external defibrillator) training. The AED is located at the WLL Concession Stand at Shawmut Hills Elementary. 6) Coaches at all levels of WLL will complete the online “Heads Up” Concussion training for youth sports available at: http://www.cdc.gov/concussion/headsup/training/ 7) Whenever possible, instructional clinics will be made available to all WLL Coaches. In addition, all umpires must attend the umpire’s clinic as directed by the Umpire in Chief 8) All WLL Coaches will receive an equipment bag for team use. The contents of the bag will haven been inspected by WLL Equipment Managers, prior to distribution. Each equipment bag will include a first aid kit. Coaches are to have the first aid kit on hand at all practices and games. All WLL issued equipment is to be returned at the end of the season. 9) All WLL Coaches shall inspect their equipment prior to all practices and games to ensure that damaged items are replaced or taken out of use and destroyed when necessary. Any equipment issues should be reported to the WLL Equipment Managers. 10) All WLL Coaches and Umpires are required to walk/inspect their fields prior to practices and games. Any field or facility issues should be reported immediately to the WLL Safety Officer 11) Any accidents should be reported to Safety Officer or League President immediately. WLL will use the incident tracking form provided by Little League International (see appendix) to achieve prompt accident reporting. Completed forms are to be provided to the WLL Safety Officer within 48 hours of the incident. This manual includes all necessary insurance forms. 12) Western Little League will abide by Official Little League Rules. A copy of WLL’s Local Rules are included in this manual. Coaches are expected to enforce all rules and to emphasize safety first at all games and practices. www.GRWESTERNLL.com 3 2014 WESTERN LITTLE LEAGUE SAFETY MANUAL – SEVERE WEATHER POLICY Western Little League will adhere to the Severe Weather Policy used by District 9 of Michigan. • If a Severe Thunderstorm Warning and/or Tornado Warning/Watch are in effect ½ hour prior to the arrival of teams at the fields for games, all games WILL BE cancelled. • Games may proceed if a Thunderstorm or Tornado Watch are issued during play. • In the event of thunder and/or lightning, ALL players must be immediately removed from the playing field by their respective coaches. They may be kept in the dugouts as long as one coach is present. Players may be released to their parents/guardians. • On fields where covered dugouts are not present, players will be reunited with their parents/guardians to seek shelter in personal vehicles. • Play will be halted until the severe weather had cleared the area. • Play will not resume until 20 minutes have elapsed without an occurrence of thunder or lightning. • Coaches who fail to follow these procedures will be subject to disciplinary action. • Any cancellations due to severe weather will be posted to the Western Little League website (www.GRWESTERNLL.com). Additionally, WLL will attempt to issue notifications of any cancellations via the league’s information systems. • All coaches will establish procedures to contact their players in the event of cancellations. • Cancelled games will be rescheduled at the discretion of the League VP, the respective coaches, and the WLL Board of Directors. In the event of rain, please arrive at the field for the normal scheduled game. We can make the determination for cancellation at or near game time. www.GRWESTERNLL.com 4 2014 WESTERN LITTLE LEAGUE SAFETY MANUAL – CONCESSION STAND INFORMATION Western Little League Concessions Manager: Sabra Szczepaniak Phone: 616.589.4948 Email: sabrapta@yahoo.com • The Concessions Manager will receive a copy of the 2014 Western Little League Safety Manual. A meeting will be held in late March with all concessions workers to review all safety issues and to discuss proper food handling practices. • No person under the age of 13 will be allowed to handle money, or serve hot items such as popcorn, coffee, or grilled items. • Workers will wash their hands prior to handling any food products. • All volunteers working in the concession stand will be required to sign in at the beginning of their shift and sign out upon their departure. • Each scheduled group will designate one person to oversee the cash register. This designation is to be communicated with the concession manager. • Concession Volunteers are to remain until the end of ALL weeknight games. Saturday shifts will cover a two-hour period. Volunteers are to arrive 15 minutes prior to their shift. • Only authorized personnel are to be in the food service area while the concession stand is open. Coaches, umpires and players are NOT to be in the food service area. • Concession stand volunteers may NOT consume any item in the concession stand unless it has been purchased. • All Team Beverage purchases must be paid before players are allowed to select an item. All Team purchases should be recorded and crossed out upon the distribution of the items. www.GRWESTERNLL.com 5 2014 WESTERN LITTLE LEAGUE SAFETY MANUAL – LOCAL RULES Note: Nothing in these local rules will interfere with the official rules and regulations of little league baseball incorporated or the Constitution of Western little league. Formation of Teams The drafting method for all divisions will be determined by the WLL Board of Directors. Division Alignment for the 2014 Season will be consist of the following: Boys and Girls 4,5 Years old Mush ball Boy and Girls 6,7 Years old Tee-Ball Boys and Girls 7,8 Years old Coach Pitch Boys 9 & 10 years old Boys Minors Boys 11 & 12 Years old Boys Majors Boys 13 &14 Years old Boys Juniors Boys 15 &16 Years old Boys Seniors Girls 8,9 & 10 Years old Girls Minors Girls 11&12 Years old Girls Majors Girls 13&14 Years old Girls Juniors Girls 15 & 16 Years old Girls Seniors Boys Age as of 4/30/2014 (League Age) Girls Age as of 12/31/2013 (League Age) Age restrictions may be changed to properly adjust team sizes and numbers. (e.g 7 year old may play coach pitch if they have played a season or more of Tee-ball and the teams in Coach Pitch need additional players). Any player movement must be approved by the WLL Board of Directors. All decisions will be final. The player agent must approve all call-ups from the Minor League to the Major League. No Minor league player called up to the Major League may play more innings than a regular Major League player unless required by injury or illness or to fill out the team. The Player Agent must approve all 8 year olds that are to play Minor League. No player may step down without the approval of the WLL Board of Directors and parental consent. An evaluation of player’s ability must be performed in order for this provision to take place. www.GRWESTERNLL.com 6 Selection of Coaches Managers must apply and will be selected based on the rules and regulations of Little League International as described in the WLL Constitution. Any Board member, coach, player or volunteer not sincerely interested in promoting the objectives of WLL may be removed by the WLL Board of Directors as described in the Little League rulebook. The President is to appoint coaches at his/her discretion. The Board of Directors must approve these appointments. A President and/or Board of Directors should not give a reason to a person if he/she is not re-appointed or re-approved. No coach has tenure, regardless of years of service. Any Board member may offer up the name of a potential coach should the President fail to do so. All Coaches, assistant coaches will complete by the Volunteer Application and consent to a Background check. The Board of Directors shall have a special meeting to approve the appointment of all coaches. The President is to schedule this meeting on or before March 1st for Mush ball to Boys/Girls Major divisions. Boys/Girls Junior, Senior Divisions should be appointed by May 1st of each season. All-Star Selection The method for selecting Tournament Teams (All-Star) players and coaches for all divisions will be determined by the WLL Board of Directors on an annual basis. For the 2014 Baseball Season the method for selecting the All-Star Coaches is as follows: The President will ask each coach in the Minors and Majors Division on an individual bases if they are interested in being selected as a All-Star Coach. All interested parties will be listed on a ballot on or around May 20 2014 at a time yet to be determined at which time the coaches will conduct a blind vote. NO SOLICITATION for votes should take place prior to this date. Votes will be counted behind the concession stand with all parties in attendance. After which the board will meet and give its approval for the coaches to proceed. For Minors, the Coach with the most votes will be deemed the All-Star Manager subject to Board approval. The Coach with the next largest number of votes will have the option of becoming the “B” team coach. For Majors, coaches must notify the WLL President as to which level they want to be considered, e.g the 11/12-year-old team or the 11-year-old team. All-Star players selected will be responsible for the cost of the uniform (not to exceed $25.00). The WLL Board of Director will determine the amount of League funds for All-Star teams on an annual basis. The best interests of Western Little League will be considered in reaching this decision. www.GRWESTERNLL.com 7 Field Preparation/Maintenance The home team manager and/or coaches will chalk the field in all divisions prior to beginning of each game. Major and Minor coaches will remove tarps and sand bags from home plate and the pitcher’s mound. The visiting manager/or coach will rake the field in all divisions following each game and replace the tarps and sand bags on home plate and the pitcher’s mound. Coaches involved with the first game of the day at their field are responsible for making sure a trash receptacle is obtained from the concession area. Coaches who play the final game of the day are responsible for returning the trash receptacle at their field to the concession area. Coaches are responsible for ensuring the removal of all trash from the dugout immediately after games. Player/Fan Conduct Any coach, player or spectator who is abusive in any manner will be asked to leave. This decision is solely and completely the decision of the acting Field Director. The decisions of the Field Director (Posted at the concession stand each day) will be final. Tobacco products, Alcohol and any NON-prescription drugs are strictly prohibited at any Western Little League function. Schedule Changes Changes to the game schedule must be submitted in writing to the Vice-President of the respective division at least 1 week prior to the proposed change. The Vice-President will verify that a field and umpires (if required) are secured. Once the new time and date are finalized, the respective coaches will be notified and the change will be updated to www.GRWESTERNLL.com www.GRWESTERNLL.com 8 www.GRWESTERNLL.com 9 www.GRWESTERNLL.com 10 www.GRWESTERNLL.com 11 www.GRWESTERNLL.com 12 www.GRWESTERNLL.com 13 www.GRWESTERNLL.com 14 www.GRWESTERNLL.com 15 www.GRWESTERNLL.com 16 www.GRWESTERNLL.com 17 www.GRWESTERNLL.com 18 www.GRWESTERNLL.com 19 www.GRWESTERNLL.com 20 www.GRWESTERNLL.com 21 www.GRWESTERNLL.com 22 www.GRWESTERNLL.com 23 www.GRWESTERNLL.com 24 www.GRWESTERNLL.com 25 www.GRWESTERNLL.com 26 www.GRWESTERNLL.com 27 www.GRWESTERNLL.com 28 www.GRWESTERNLL.com 29 www.GRWESTERNLL.com 30 www.GRWESTERNLL.com 31 www.GRWESTERNLL.com 32 State Special professional training, skills, hobbies: Zip State ® of which contain name only searches which may result in a report being generated that LOCAL LEAGUE USE ONLY: System)s) used for background check (minimum of one must be checked): *Please be advised that if you use First Advantage and there is a name match in the few states be the league volunteer. 33 www.GRWESTERNLL.com No Little League® “Returning” Volunteer Application - 2014 Coach Umpire Field Maintenance Other: __________________________ Name / Phone: ________________________________________________ ________________________________________________ ________________________________________________ Criminal History Records *First Advantage Only attach to this application copies of background check reports that reveal convictions of this application. *Please be advised that if you use First Advantage and there is a name match in the few states where only name match searches can be performed you should notify volunteers that they will recieve a letter directly from First Advantage in compliance with the Fair Credit Reporting Act containing information regarding all the criminal association with the name, which may not necessarily be the league volunteer. Sex Offender Registry System(s) used for background check (minimum of one must be checked): Background Check completed by league officer ________________________________________________ on _____________________________________________________________________________________ LOCAL LEAGUE USE ONLY: ____________________________________________________________________________ Previous volunteer experience (including baseball/softball and year(s)): ____________________________________________________________________________ ____________________________________________________________________________ Special Affiliations (Clubs, Service Organizations, etc): ____________________________________________________________________________ Special Certifications (CPR, Medical, etc): ____________________________________________________________________________ Special professional training, skills, hobbies: / __________________________ / __________________________ / __________________________ Please list three references, at least one of which has knowledge of your participation as a volunteer in a youth program: Home Phone: ______________________________ Cell or Work Phone: _________________ E-Mail Address: _______________________________________________________________ Driver’s License #: _________________________________________________ State: _______ Occupation: __________________________________________________________________ Employer: ____________________________________________________________________ Address: _____________________________________________________________________ Name: _______________________________________________________________________ Address: _____________________________________________________________________ City: ____________________________________________ State: _______ ZIP: ___________ Please update only the information in this section which has changed since last year. Do not use forms from past years. Use extra paper to complete if additional space is required. If you filled out a volunteer application last year and your league uses the background check tools provided by Little League International, please fill out the returning volunteer application. Otherwise, please use the standard volunteer application. You must provide the information to all the questions in this section Yes Have you ever been convicted or plead guilty to any crime(s) involving or against a minor? If Yes, describe each in full: ____________________________________________________ __________________________________________________________________________ No Are there any criminal charges pending against you regarding any crime(s) involving or against a minor? Yes If Yes, describe each in full: ____________________________________________________ __________________________________________________________________________ Have you ever been refused participation in any other youth program? Yes No If Yes, explain: _______________________________________________________________ Concession Stand Manager In which of the following would you like to volunteer? (Check one or more) League Official Score Keeper AS A CONDITION OF VOLUNTEERING, I give permission for the Little League organization to conduct background check(s) on me now and as long as I continue to be active with the organization, which may include a review of sex offender registries (some of which contain name only searches which may result in a report being generated that may or may not be me), child abuse and criminal history records. I understand that, if appointed, my position is conditional upon the league receiving no inappropriate information on my background. I hereby release and agree to hold harmless from liability the local Little League, Little League Baseball, Incorporated, the officers, employees and volunteers thereof, or any other person or organization that may provide such information. I also understand that, regardless of previous appointments, Little League is not obligated to appoint me to a volunteer position. If appointed, I understand that, prior to the expiration of my term, I am subject to suspension by the President and removal by the Board of Directors for violation of Little League policies or principles. Applicant Name (please print or type): ___________________________________________________ Applicant Signature: ________________________________________ Date: ____________________ If Minor — Parent Signature: _________________________________ Date: ____________________ NOTE: The local Little League and Little League Baseball, Incorporated will not discriminate against any person on the basis of race, creed, color, national origin, martial status, gender, sexual orientation or disability. 34 www.GRWESTERNLL.com Little League Baseball & Softball ® CLAIM FORM INSTRUCTIONS WARNING — It is important that parents/guardians and players note that: Protective equipment cannot prevent all injuries a player might receive while participating in baseball/softball. To expedite league personnel’s reporting of injuries, we have prepared guidelines to use as a checklist in completing reports. It will save time -- and speed your payment of claims. The National Union Fire Insurance Company of Pittsburgh, Pa. (NUFIC) Accident Master Policy acquired through Little League® contains an “Excess Coverage Provision” whereby all personal and/or group insurance shall be used first. The Accident Claim Form must be fully completed, including a Social Security Number, for processing. To help explain insurance coverage to parents/guardians refer to What Parents Should Know on the internet that should be reproduced on your league’s letterhead and distributed to parents/guardians of all participants at registration time. If injuries occur, initially it is necessary to determine whether claimant’s parents/guardians or the claimant has other insurance such as group, employer, Blue Cross and Blue Shield, etc., which pays benefits. (This information should be obtained at the time of registration prior to tryouts.) If such coverage is provided, the claim must be filed first with the primary company under which the parent/guardian or claimant is insured. When filing a claim, all medical costs should be fully itemized and forwarded to Little League International. If no other insurance is in effect, a letter from the parent/guardian or claimant’s employer explaining the lack of group or employer insurance should accompany the claim form. The NUFIC Accident Policy is acquired by leagues, not parents, and provides comprehensive coverage at an affordable cost. Accident coverage is underwritten by National Union Fire Insurance Company of Pittsburgh, a Pennsylvania Insurance company, with its principal place of business at 175 Water Street, 18th Floor, New York, NY 10038. It is currently authorized to transact business in all states and the District of Columbia. NAIC Number 19445.This is a brief description of the coverage available under the policy. The policy will contain limitations, exclusions, and termination provisions. Full details of the coverage are contained in the Policy. If there are any conflicts between this document and the Policy, the Policy shall govern. The current insurance rates would not be possible without your help in stressing safety programs at the local level. The ASAP manual, League Safety Officer Program Kit, is recommended for use by your Safety Officer. www.GRWESTERNLL.com 35 TREATMENT OF DENTAL INJURIES Deferred Dental Treatment for claims or injuries occurring in 2002 and beyond: If the insured incurs injury to sound, natural teeth and necessary treatment requires that dental treatment for that injury must be postponed to a date more than 52 weeks after the date of the injury due to, but not limited to, the physiological changes occurring to an insured who is a growing child, we will pay the lesser of the maximum benefit of $1,500.00 or the reasonable expense incurred for the deferred dental treatment. Reasonable expenses incurred for deferred dental treatment are only covered if they are incurred on or before the insured’s 23rd birthday. Reasonable Expenses incurred for deferred root canal therapy are only covered if they are incurred within 104 weeks after the date the Injury is sustained. CHECKLIST FOR PREPARING CLAIM FORM 1. Print or type all information. 2. Complete all portions of the claim form before mailing to our office. 3. Be sure to include league name and league ID number. PART I - CLAIMANT, OR PARENT(S)/GUARDIAN(S), IF CLAIMANT IS A MINOR 1. The adult claimant or parent(s)/guardians(s) must sign this section, if the claimant is a minor. 2. Give the name and address of the injured person, along with the name and address of the parent(s)/guardian(s), if claimant is a minor. 3. Fill out all sections, including check marks in the appropriate boxes for all categories. Do not leave any section blank. This will cause a delay in processing your claim and a copy of the claim form will be returned to you for completion. 4. It is mandatory to forward information on other insurance. Without that information there will be a delay in processing your claim. If no insurance, written verification from each parent/spouse employer must be submitted. 5. Be certain all necessary papers are attached to the claim form. (See instruction 3.) Only itemized bills are acceptable. 6. On dental claims, it is necessary to submit charges to the major medical and dental insurance company of the claimant, or parent(s)/guardian(s) if claimant is a minor. “Accident-related treatment to whole, sound, natural teeth as a direct and independent result of an accident” must be stated on the form and bills. Please forward a copy of the insurance company’s response to Little League International. Include the claimant’s name, league ID, and year of the injury on the form. PART II - LEAGUE STATEMENT 1. This section must be filled out, signed and dated by the league official. 2. Fill out all sections, including check marks in the appropriate boxes for all categories. Do not leave any section blank. This will cause a delay in processing your claim and a copy of the claim form will be returned to you for completion. IMPORTANT: Notification of a claim should be filed with Little League International within 20 days of the incident for the current season. www.GRWESTERNLL.com 36 LITTLE LEAGUE® BASEBALL AND SOFTBALL ACCIDENT NOTIFICATION FORM INSTRUCTIONS Send Completed Form To: ® Accident Claim Contact Numbers: Limited ( ) ( ) excess each (4-18) (4-7) (6-12) INTERMEDIATE (50/70) (11-13) JUNIOR (12-14) SENIOR (13-16) BIG (14-18) www.GRWESTERNLL.com 37 For Residents of California: For Residents of New York: For Residents of Pennsylvania: For Residents of All Other States: PART 2 - LEAGUE STATEMENT (Other than Parent or Claimant) POSITION WHEN INJURED INJURY PART OF BODY www.GRWESTERNLL.com CAUSE OF INJURY 38 For Local League Use Only A Safety Awareness Program’s Incident/Injury Tracking Report Activities/Reporting League Name: _____________________________ League ID: ____ - ___ - ____ Incident Date: __________ Field Name/Location: _________________________________________________ Incident Time: __________ Injured Person’s Name: ______________________________________ Date of Birth: ___________________ Address: __________________________________________________ Age: ________ Sex: ❒ Male ❒ Female City: ____________________________State ________ ZIP: ________ Home Phone: ( ) _____________ Parent’s Name (If Player): ____________________________________ Work Phone: ____________ ) _____________ ( Parents’ Address (If Different): _________________________________ City ___________________________ Incident occurred while participating in: A.) ❒ Baseball ❒ Softball ❒ Challenger ❒ TAD B.) ❒ Challenger ❒ T-Ball (4-7) (5-8) (7-11) ❒ Minor (7-12) ❒ Major (9-12) Senior (13-16)(16-18) Big League (15-18) ❒ Junior Senior(12-14) (14-16) ❒ Big League C.) ❒ Tryout ❒ Practice ❒ Game ❒ Tournament ❒ Travel to ❒ Travel from (50/70) (11-13) ❒ Intermediate Junior (13-14) ❒ Special Event ❒ Other (Describe): ________________________________________ Position/Role of person(s) involved in incident: D.) ❒ Batter ❒ Baserunner ❒ Pitcher ❒ Catcher ❒ First Base ❒ Second ❒ Third ❒ Short Stop ❒ Left Field ❒ Center Field ❒ Right Field ❒ Dugout ❒ Umpire ❒ Coach/Manager ❒ Spectator ❒ Volunteer ❒ Other: __________________ Type of injury: _____________________________________________________________________________ _________________________________________________________________________________________ Was first aid required? ❒ Yes ❒ No If yes, what:________________________________________________ Was professional medical treatment required? ❒ Yes ❒ No If yes, what: ____________________________ (If yes, the player must present a non-restrictive medical release prior to to being allowed in a game or practice.) Type of incident and location: A.) On Primary Playing Field ❒ Base Path: ❒ Running or ❒ Sliding ❒ Hit by Ball: ❒ Pitched or ❒ Collision with: ❒ Player or ❒ Thrown or ❒ Batted ❒ Structure B.) Adjacent to Playing Field ❒ Seating Area ❒ Parking Area C.) Concession Area D.) Off Ball Field ❒ Travel: ❒ Car or ❒ Bike or ❒ Walking ❒ Grounds Defect ❒ Volunteer Worker ❒ League Activity ❒ Other: ____________________________________ ❒ Customer/Bystander ❒ Other: ________ Please give a short description of incident: ____________________________________________________ _________________________________________________________________________________________ Could this accident have been avoided? How: __________________________________________________ This form is for Little League purposes only, to report safety hazards, unsafe practices and/or to contribute positive ideas in order to improve league safety. When an accident occurs, obtain as much information as possible. For all claims or injuries which could become claims, please fill out and turn in the official Little League Baseball Accident Notification Form available from your league president and send to Little League Headquarters in Williamsport (Attention: Dan Kirby, Risk Management Department). Also, provide your District Safety Officer witha copy for District files. All personal injuries should be reported to Williamsport as soon as possible. Prepared By/Position: ____________________________________ Phone Number: (_____) _____________ Signature: _____________________________________________ Date: _____________________________ www.GRWESTERNLL.com 39
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