PLL Preliminary Incident Report

Gender:

- Incident and Injury Information -

Was First Aid Required?  If so, what?
 
Was Professional Medical Treatment Required?  If so, What?
 
Type Ball:

Injured person was:

Position when injured:

 
Type of Injury:
 
Injured Body Part:
 
Cause of Injury:
 
Were there any witnessess to the accident?  Who/phone #?
 
Could this accident have been avoided?  If so, how?
 
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