State Park Little League Safety Mission Statement State Park Little League will provide a safe, enjoyable, family oriented, learning

environment for the children of our community.

STATE PARK LITTLE LEAGUE

2017

SAFETY MANUAL

� CONTACT INFORMATION�

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EMERGENCY STATE PARK Little League

Porter Police/Fire/EMTPMH AmbulancePoison Control Center

911911(800) 222-1222

State Park Little League250 League LanePorter, IN 46304www.stateparklittleleague.com

Non- Emergency Contact Numbers Safety Committee

Porter PolicePorter FirePorter County Sheriff

(219) 926-7611(219) 926-1226(219) 477-3000

Safety Officer Rich Hawksworth -Facilities Adam Kurek -Equipment Mike Rubens

(312) 337-6000(219) 314-3237(219) 757-1165

UTILITIES – EMERGENCY State Park Board of Directors

NIPSCOIndiana American WaterChesterton Sewer

(800) 634-3524(800) 492-8373(219) 926-1136

President Zac McConnellVice President Chris ColeTreasurer Brian CzarnieckiSecretary/Info Chris HackettBB Player Agent Bruce Chafffee SB Player Agent Todd Schrenk Coaching Coord. Mike Burke Challengers VP Equipment Mike Rubens Safety Officer Rich Hawksworth Umpires Rich HawksworthConcessions Sharon Arndt Groundskeeper Adam Kurek Sponsorship Christina Griffin Inform. Officer Michelle Chaffee Board Member Steve McClelland

(219) 545-5020(219) 405-6820(219) 476-5999(219)(219) 331-6326(219) 921-6458(219) 728-7232

(219) 757-1165(312) 337-6000(312) 337-6000(219) 741-9985(312) 314-3237(219) 707-3563(219) 331-6561(219) 741-4901

UTILITIES – Non-Emergency Additional Contact Information

NIPSCOIndiana American WaterChesterton Sewer

(800) 464-7226(800) 492-8373(219) 926-1032

Area Hospitals District One Staff

Porter Regional Hospital85 E. US Hwy 6Valparaiso, IN 46385

St. Anthony Memorial810 Michael DriveChesterton, IN 46304

(219) 983-8300

(219) 395-2197

Administrator Rich Arndt Safety Beverly Vild

(773) 551-1185(219) 331-4405

TABLE OF CONTENTS

Emergency Phone List Page 2

Table of Contents Page 3

Letter from Safety Officer Page 4

Requirement #1 (Have an active Safety Officer on file with Little League International.)

Page 6

Requirement #2 (Publish and distribute a paper copy of the applicable safety manual to all appropriate and applicable volunteers.)

Page 6

Requirement #3 (Post and distribute emergency and key officials' phone numbers.)

Page 6

Requirement #4 (Use the Little League official Volunteer Application Form and check for sexual abuse.)

Page 6

Requirement #5 (Provide and require fundamentals training, with at least one coach or manager from each team attending.)

Page 6

Requirement #6 (Require first-aid training for coaches and managers, with at least one coach or manager from each team attending.)

Page 7

Requirement #7 (Require coaches/umpires to walk fields for hazards before use.)

Page 7

Requirement #8 (Complete the annual Little League Facility Survey.)

Page 7

Requirement #9 (Have written safety procedures for concession stand; concession manager trained in safe food handling/prep and procedures.)

Pages 8–10

Requirement #10 (Require regular inspection and replacement of equipment.)

Pages 10

Requirement #11 (Implement prompt accident reporting and tracking procedures.)

Pages 11

Requirement #12 (Require a first-aid kit at each game and practice.)

Pages 11–12

Requirement #13 (Enforce Little League rules including proper equipment.)

Pages 12

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Requirement #14 (Qualified Safety Plan Registration Form)

Pages 12

Requirement #15 (League Player Registration Data or Player Roster Data, Coach and Manager Data)

Pages 13

State Park Little League 2017 Safety Code Pages 15–16

The State Park Little League Safety Organization Page 17

The State Park Little League Parental Safety Page 18

The State Park Little League Facilities and Equipment Safety Page 19

The State Park Little Leagues Do’s and Don’ts for Managers/Coaches Page 20

State Park Little League Field Inspection Form Page 21

State Park Little League Injury Report Page 22

State Park Little League Safety Manual Receipt Page 23

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LETTER FROM THE SAFETY OFFICERMy name is Rich Hawksworth and I am serving as the State Park Little League Safety Officer. It is my goal to provide a safe environment for all of the families of the State Park Little League. In order for this goal to be executed, a 100% safety conscious membership is required.

The State Park Little League's highest priority is for the safety of our kids. Prevention is the key to reducing accidents. At State Park Little League we are committed to encouraging safety and providing a safe environment to be in. In order to succeed we need your commitment to becoming safety conscious volunteers.

The purpose of this manual is to provide important safety information to State Park Little League. While specifically written for Managers, and Coaches the information contained in this document can be a useful resource for all participants of State Park Little League. Please take the time to review this manual in its entirety. Each Manager, Board Member and Volunteer receives a copy of the Safety Manual and is required by return receipt (located as the last page of the Safety Manual) to confirm they have read and understand the policies.

Although accidents do happen, most of them can be prevented. With continuous education, commitment, and execution of safety practices on and off of the field, the State Park Little League can stride through each season injury free. Safety awareness is the key to prevention.

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EMERGENCY PROTOCOL 1. Call 911 2. Relate nature of injury and location of victim 3. Care for victim until EMS arrives 4. If possible, locate SPLL Staff Member for assistance 5. Designate locator to direct EMS to victim

ORGANIZATION • Active Safety Officer Board Member on File with Little League International – Rich

Hawksworth. (Requirements #1 & 18)

• State Park Little League allocates a portion of its annual budget for safety. (Requirement #21)

• Each Manager, Board Member and Volunteer receives a copy of the Safety Manual and is required by return receipt (located as the last page of the Safety Manual) to confirm they have read and understand the policies. (Requirement #2)

• The Safety Manual includes phone numbers for Board Members, and key District personnel. Safety Manual is kept in the press box, all satellite fields, the concession stand, and posted online. (Requirement #3)

• The Safety Manual will be reviewed by the District Administrator prior to its submission to Little League. (Requirement #17)

• SPLL uses the 2017 Little League International Volunteer Application Form (online) and checks for sex abuse history as well as criminal background. SPLL requires all managers, coaches, board members and any others, volunteers or hired workers, who provide regular services to the league and/or have repetitive access to or contact with players or teams must fill out an application form as well as provide a government-issued photo identification card for ID verification. SPLL conducts a search of the appropriate governmental entity of the nationwide sex offender registry on all volunteer applications received through First Advantage National Criminal File. When using First Advantage for background checks, Social Security numbers must be submitted and are required to be entered on the application form. Anyone refusing to fill out a volunteer application completely is ineligible to be a league member or volunteer. The league Safety Officer is required to retain these confidential forms for one year of service. (Requirement #4)

• An example of the Volunteer Application form can be found online: (http://assets.ngin.com/attachments/document/0075/0210/volunteer-app.pdf). All forms must be presented to a SPLL member in paper form and having all fields of the application completed. SPLL members are required to turn all completed application to the SPLL Safety Officer, Rich Hawksworth

• Emergency telephone numbers (as listed in Safety Manual) are posted at all times in the press boxes, all satellite fields and in the concession stand.

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• SPLL continuously notifies coaches of local coaches’ clinics provided by private vendors, high schools and local universities. ALL Managers, Coaches and League Umpires will participate in fundamentals training on March 22, 2017. Fundamental training qualifies a volunteer for 3 years; but one team representative is still required each year to attend the training. The following items are discussed but not limited to hitting, pitching, catching, fielding, running, and sliding. (Requirements #5, #31)

TRAINING • SPLL continuously notifies coaches of local first-aid training provided by private vendors,

high schools and local universities. ALL Managers, Coaches and League Umpires participate in first-aid and CPR training on March 22, 2017. This training includes instructing coaches and managers about heat illness warning signs. First-aid training qualifies a volunteer for 3 years; but one team representative is still required each year to attend the training. The following items are discussed but not limited to:

✴ First aid, including overuse injuries particularly of the shoulder✴ Recognition of heat related illness✴ Communicable Diseases✴ Lightning safety

(Requirements #6, #25, #29, #30)

• State Park Little League enforces a policy that no children may chase foul balls due to traffic concerns and visibility. Enforcement of policy is delegated to the coaches of the team in the field and board members on Field Representative duty.

FACILITIES • The home team manager is encouraged to inspect and prepare the field for play prior to all

games and practices. This inspection includes removal of loose impediments, trash, debris, and assure fencing is intact with no loose edges or breakdown. A SPLL field inspection form may be completed and turned into the designated area in the concession stand upon inspection of the fields. (Requirement #7)

• To help the State Park Little League find and correct facility concerns, an annual Little League Online Survey is completed and submitted to Little League International. (Requirement #8)

• Concession stand safety procedures (see below) are posted and discussed with Concession Manager TBD. (Requirement #9)

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Safety Procedure for Concession Workers

ARRIVAL: Workers must arrive 15 minutes before your shift. If you are helping to open for the first game of the day, you are requested to arrive earlier. Service window should be open fifteen (15) minutes before the game.

WASH HANDS: Hand cleanliness cannot be stressed enough! Wash with soap and water before your shift, after eating, and after you use the restroom.

NO FREE FOOD: When purchasing food, give your money to another worker to place in the drawer. They will make change, if necessary. Try to eat by the door, one at a time, and only during slow periods. (Workers are allowed two items during your shift without charge. Anything above this must be paid for).

KEEP STAND CLEAN: Always wipe counter, tidy up work areas, pick up trash, and sweep when necessary.

GARBAGE: Empty when needed! When can is near full, remove and place bag in dumpster, replace bag.

RESTOCK FREQUENTLY: Keep the shelves and supplies full, don’t wait for someone else to fill.

ONE KITCHEN WORKER AT ALL TIMES: The workers can decide who starts in the kitchen, then switch so everyone gets a turn. Keep time if necessary for equality.

NO CHECKS: Cash only, no checks accepted. No tabs.

CUSTOMER SERVICE: Be friendly, helpful and courteous to everyone, especially customers.

HONESTY: If caught stealing, you will be immediately removed, and possibly face prosecution.

CALL OFF: If you cannot work your scheduled shift, you must notify Sharon Arndt as soon as possible. If s/he is not available, contact Nicole Kurek (219) 929-7659.

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CONCESSION WORKERS

Food Safety Guide

1. Workers must wash hands and utensils prior to preparing food.

2. Workers must wash hands after handling any/all meat products.

3. Cutting boards and counters must be washed with hot, soapy water.

4. Paper towels rather than sponges must be used for cleaning, and disposed of properly when finished.

5. Refrigerator must be cleaned daily.

6. Refrigerator must be occasionally checked to insure the temperature does not rise above forty (40) degrees Fahrenheit.

7. Freezer must be occasionally checked to insure the temperature does not go above zero (0) degrees Fahrenheit.

Equipment Set-up Guide

HOT DOG ROASTER: Begin the day with twelve (12) Hot Dogs and three (3) Polish Sausage. Place roaster on high. Turn on the warmer underneath the Hot Dog rotisserie to 200 degrees and ½ cup of water in each side. Once Hot Dogs are cooked they are wrapped in aluminum foil and placed in steamer.

COFFEE MACHINE: Start cold days with two (2) pots of coffee. Use ¼ cup of coffee. Filters are located above the coffee machine.

CHILI/CHEESE: Chili and cheese machines operate exactly the same. Push button in carefully, as the product will come out fast! To change the bag, open machine and unscrew cap. Rinse cap and place on new bag. Replace in the machine. There should be two (2) bags of cheese in the machine at once, and only one (1) bag of chili.

POPCORN: Turn both switches in when beginning and place entire contents of packet in kettle. Once it completes popping, flip handle on kettle and dump popped corn. Begin the day with three (3) batches.

SODA POP MACHINE: Make sure the ice bin portion is full of ice at all times--especially at the end of the night.

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EQUIPMENT

All equipment has been inspected and replaced. Any equipment deemed unsafe or deficient by Equipment Manager Mike Rubens or Safety Officer Rich Hawksworth will be scrapped, and rendered unusable. All equipment meets Little League standards. (Requirement #10)

• INSPECTION – Inspect equipment regularly and make sure it fits properly.

• CATCHERS – Catchers must wear catcher's helmet, mask, throat protector, shin guards, long model chest protector, and protective cup at all times.

• PITCHER’S WARM-UP – Catchers must wear catcher's helmet, mask, throat protector, and protective cup when warming up pitchers.

• GLASSES – Parents should be encouraged to provide safety glasses for their children wearing glasses.

• MOUTH AND FACE GUARDS/CUPS – Parents should be encouraged to provide mouth and face guards and protective cups for their children.

• SAFETY BASES – All coaches must use safety bases which are located in equipment boxes at each field.

• BATS – All bats must comply with Little League International Regulations. (http://www.littleleague.org/learn/equipment/baseballbatinfo.htm)

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INJURIES AND ACCIDENTS

All managers receive State Park Injury report form/s and are responsible for submitting such to the Safety Officer on an occurrence basis, within 24 hours of incident. Forms are provided in the back pages of this safety manual. (Requirement #11)

Accident Procedure:

• Administer First Aid to the level of your training. Call 911 if necessary.

• Reassure the injured party and spectators.

• Contact the injured part's parent or guardian. If unavailable, contact the emergency contact listed on the registration form.

• Control the crowd.

• Talk to your team about the situation. Often players are upset and worried when a teammate is injured. They need to feel safe and understand why the injury occurred.

• Any injury requiring professional medical care will need a physician's clearance prior to returning to play. Contact your league Safety Officer by phone within 24 hours of the incident.

Communicable Diseases (additional information Appendix C):

• Bleeding must be stopped, open wounds covered, and the uniform changed if there is blood on it before the athlete may return to play.

• Use gloves when coming in contact with blood or body fluids. Gloves are provided in all First Aid kits.

• Immediately wash hands with soap and other skin surfaces contaminated with blood.

• Clean blood contaminated surfaces and equipment.

• Store blood or body fluid contaminated uniforms or gear in plastic bags for thorough cleaning at home.

• Place all blood and body fluid contaminated First Aid equipment (i.e. bloody gloves, bloody dirt, etc.) in a zip-lock bag. Seal the bag and throw it into a trash can. Zip-lock bags are provided in all First Aid kits.

FIRST AID

A master first-aid kit is available at the State Park Little League fields. Individual First Aid kits are distributed to all managers and coaches when they receive their equipment. Every

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manager and coach is required to have in their possession a first aid kit at all times. The Safety Officer is responsible for the coordination of the safety equipment. The Safety Officer is responsible to make sure that every manager and coach has a first aid kit which is fully stocked. Replenishment of supplies is available by contacting Safety Officer Rich Hawksworth (richhawksworth@mac.com or 312-337-6000). (Requirement #12)

First aid kits include:

• 40 Plastic Bandages 3/4" x 3"

• 8 Plastic Bandages 2" x 4.5"

• 6 Gauze Pads 4" x 4"

• 1 Roll Gauze 2"

• 1 Roll Gauze 4"

• 1 Elastic Bandage 3" x 5yds.

• 20 Antiseptic Wipes

• 6 Sting Relief Wipes

• 1 Tape 1/2" x 5 yds.

• 1 Tape 1" x 5 yds.

• 4 Cold Packs

• 1 Scissors

• 4 Gloves

• 10 Triple Antibiotic Ointment Packets

The State Park Little League follows in accordance with the Little League rules and standards and will be enforced at all games and practices. The State Park Little League Board of Directors is responsible for enforcing the existing Little League rules. Managers, coaches, and umpires should be thoroughly familiar with the current Little League Rule Book. Enforcement of Little League rules is the responsibility of every participant and the Board will enforce its rules if violated. (Requirement #13)

In order for this Safety Manual to be accepted by Little League International a Qualified Safety Plan Registration Form must be completed and submitted. Upon receipt of this Safety Manual this requirement has been met and the Safety Manual has been accepted by the Little League International for use. (Requirement #14)

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The State Park Little League will also submit a player registration data or player roster data and coach and manager data via the Little League Data Center at www.LittleLeague.org. This is a mandatory requirement for an approved ASAP plan in 2014. (Requirement #15)

AED (Automatic External Defibrillator)

State Park Little League has an AED (Automatic External Defibrillator) available in case of cardiac emergency. The unit is located in the concession stand and board members and other volunteer staff are trained in its use.

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STATE PARK LITTLE LEAGUE2017 SAFETY CODE

• Managers, Coaches, and umpires should have some training in First-Aid. First-Aid Kits should be available at the field and must be inspected weekly. After each use contact the Safety Officer for re-supply.

• Play area should be inspected frequently for holes, damage, stones, glass, and other foreign objects.

• Dugouts should be free and clear of debris and inspected regularly. Dugout must be cleaned and swept before players leave.

• Bleacher area must be cleared of trash and debris.

• Only players, Managers, Coaches, and umpires are permitted on the playing field during play and practice sessions. The batting team is allowed two base coaches on first base and third base. All other Managers and coaches are to remain in the dugout. (With the exception of Instructional and T-ball) Players, coaches and managers may not leave the dugout except to use the restroom or receive first aid.

• No batboys or batgirls are allowed in the dugout or on the field.

• No more than three adults in total are allowed in the dugout or on the field.

• Only a fully equipped catcher is allowed to warm up a pitcher. Catchers must wear a catcher's helmet (with face mask and throat guard), chest protector, and shin guards. Male catchers must wear long-model chest protector, protective supporter, and cup at all times.

• Managers must record pitches for each pitcher in the pitcher’s record log located in the concession stand.

• During practice sessions and games, all players should be alert and watching the batter on each pitch.

• During warm-up drills, players should be spaced so that no one is endangered by wild throws or missed catches.

• As stated on page 7, ALL equipment must meet Little League Standards.

• Equipment should be inspected regularly. Make sure it fits properly.

• Batters must wear protective NOCSAE helmets during batting practice, as well as during games.

• Except when a runner is returning to a base, headfirst slides are not permitted.

• During sliding practice, bases should not be strapped down.

• The use of sliding shorts with genital protection is encouraged for all participants.

• At no time should "horse play" be permitted on the playing field

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• Parents of players who wear glasses should be encouraged to provide safety glasses with an elastic retaining strap.

• Players must not wear watches, rings, pins, jewelry, or other metallic items except it are a medical bracelet or necklace.

• Metal cleats are only allowed in the Junior Division of both baseball and softball.

• Absolutely NO on-deck batters. This means no player should handle a bat, even while in an enclosure, until it is his/her time at bat.

• Players who are ejected, ill, or injured should remain under supervision until released to the parent or guardian.

• Baseball shoes with rubber cleats molded to the sole, tennis, or gym shoes are authorized.

• Do not allow players to throw bats or helmets.

• Do not allow players to visit the restroom alone, have the child’s parent or volunteer escort the player to and from the restroom and back to the field of play.

• Report all injuries to the State Park Little League Safety Officer. Including but not limited to: the use of bandages, ice packs, the exposure of blood, or a player loses consciousness.

• Please do not visit the dugout during games. If you need your ballplayer, contact the coach.

• No Homerun Derby is allowed on empty fields.

• No pets are allowed on the premises.

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STATE PARK LITTLE LEAGUE SAFETY ORGANIZATION• Active Safety Officer Board Member on File with Little League International – Rich

Hawksworth.

• Each Manager, Board Member and Volunteer receives a copy of the Safety Manual and is required by return receipt (located as the last page of the Safety Manual) to confirm they have read and understand the policies.

• The Safety Manual includes phone numbers for Board Members, and key District personnel.

• Safety Manual is kept in the press box, all satellite fields, the concession stand, and posted online.

• Emergency telephone numbers (as listed in Safety Manual) are posted at all times in the press boxes, all satellite fields and in the concession stand.

• A current Little League Volunteer application is completed by ALL individuals who have contact with children. ALL volunteers undergo national background checks through Little League’s current mandated vendor. SPLL uses the Little League International Volunteer Application Form (online) and checks for sex abuse history as well as criminal background. Forms are then cross-referenced through First Advantage National Criminal File.

• An extra copy of the Little League Medical release is provided for Manager’s use.

• The SPLL Safety Manual is submitted and reviewed annually by a District Administrator or the District Safety Officer.

• League enforces a policy no children may chase foul balls due to traffic concerns and visibility. Enforcement of policy is relegated to the coaches of the team in the field and board members on Field Representative duty.

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STATE PARK LITTLE LEAGUE PARENTAL SAFETYThe parents of SPLL players can help by setting a good example for all the players. It is important to follow the rules for the safety of everyone involved. The managers and coaches are or will be trained in first aid fundamentals and common sense safety. Please take the time to listen to the manager and coaches, learn these rules and make them common practice any time you practice baseball with your children.

• COMPLETE A MEDICAL RELEASE – This enables emergency crews to perform needed medical attention, if parent or guardian is not in attendance, and also informs managers, coaches and medical providers of allergies or other medical problems. It is important that you share any medical information that may affect your child during games and practice. If you have concerns or questions, please contact the manager or League Safety Officer.

• NO ALCOHOL OR TOBCCO ON THE FIELD – If volunteers must smoke or chew tobacco, please do it away from the players in designated areas. If the players can see you smoke or chew, you are too close!

• PARKING LOT SAFETY – Please be extra cautious when entering and leaving the parking lots. Pedestrians may not always look for you, it is important to be aware of your surroundings.

• PLAYER STAMINA – Have your child eat a meal or snack before practice or games; hungry ball players don’t concentrate well. Be sure that your child is also able to stay well hydrated. Arrive to practice and games early to allow for proper warm ups to prevent injury during your child’s participation.

• EQUIPMENT – Routinely, check your child’s equipment for safety concerns.

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STATE PARK LITTLE LEAGUE FACILITIES AND EQUIPMENT SAFETY

• Concession stand safety procedures are posted and discussed with Concession Manager Tracey Dibble.

• Tee-ball divisions are to use reduced impact (i.e. “safety”) balls.

• All bases are disengage-able. First base is a double (safety) base.

• Warning tracks are present on both SPLL fields.

• Fence tops are covered with protective plastic.

• Only adults are allowed to ride on or use the power lawn mower.

• The State Park Little League follows in accordance with the Little League rules and standards and will be enforced at all games and practices.

• The home team manager is required to inspect and prepare the field for play prior to all games and practices. This inspection includes removal of loose impediments, trash, debris, and assure fencing is intact with no loose edges or breakdown.

• Little League Online Facility Survey has been completed.

• All equipment has been inspected and replaced. Any equipment deemed unsafe or deficient by Equipment Manager Rich Arndt or Safety Officer Rich Hawksworth will be scrapped, and rendered unusable. All equipment meets Little League standards.

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STATE PARK LITTLE LEAGUE’S DOS AND DON’TS FOR MANAGERS AND COACHES

DO....

• Make arrangements to have a cellular phone available when your game or practice is at a facility that does not have any public phones.

• Have your players’ Medical Release Forms with you at all games and practices.

• Carry your first-aid kit to all games and practices.

• Reassure and aid children who are injured, frightened, or lost.

• Provide, or assist in obtaining, medical attention for those who require it.

• Know your limitations.

• Assist those who require medical attention - and when administering aid, remember to:✴ LOOK for signs of injury (Blood, Black-and-blue deformity of joint etc.). ✴ LISTEN to the injured describe what happened and what hurts if conscious. ✴ Before questioning, you may have to calm and soothe an excited child. ✴ FEEL gently and carefully the injured area for signs of swelling, or grating of broken

bone.

DO NOT....

• Administer any medications.

• Provide any food or beverages. (other than water)

• Hesitate in giving aid when needed.

• Be afraid to ask for help if you’re not sure of the proper procedures.

• Transport injured individuals except in extreme emergencies.

• Leave an unattended child at a practice or game.

• Allow players to visit the restroom alone, have the child’s parent or volunteer escort the player to and from the restroom and back to the field of play.

• Hesitate to report any present or potential safety hazard to the Safety Officer immediately.

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STATE PARK FIELD INSPECTION

Date of Game ______________________ Field Location __________________________

Team Name ________________________ Manager Name __________________________

Items for Inspection Check when Completed

a) Fencesi) Outfield tops covered _________ii) Outfield structure intact (no holes) _________iii) On deck area secure _________iv) Dugout fences secure _________

b) Field areai) Bases secure _________ii) Pitcher’s plate filled _________iii) No loose impediments _________

c) Miscellaneousi) Trash cans out and lined _________ii) Bleachers secure _________iii) Field Equipment (drag, tarp, stored outside fence) _________

Manager Signature _____________________________________ Date _______________

PLEASE RETURN COMPLETED FORM TO CONCESSION STAND

Safety Officer Signature _________________________________ Date _______________

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STATE PARK INJURY REPORT

ATHLETE INFORMATION

FORM MUST BE COMPLETED AND TURNED INTO SAFETY OFFICER WITHIN 24 HOURS

Name: Date: Date of Injury:

Parent Name: Phone:(H) (W) (C)

Parent/Guardian Insurance:

INJURY EVALUATION

Body Part Injured: Left Right Bilateral Mechanism of Injury:

Injury Occurred During: Game Practice Severity of Injury: 1 MildOther: 2 3 Moderate 4 5 Severe

Nature of Injury: Acute Chronic Overuse Preventable?

Sprain Dislocation Contusion Laceration Other: Strain Subluxation Fracture Abrasion Tendinitis Concussion Internal Injury Avulsion Cartilage Tear

Comments: (Positive Findings/Special Tests)

Parents Notified: Y/N Manager/ Coach Notified: Y/N

Phone Phone Note Note In Person In Person Phone Message Phone Message

Manager Signature _____________________________________ Date _______________

Safety Officer Signature _________________________________ Date _______________

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STATE PARK LITTLE LEAGUESAFETY MANUAL RECEIPT

I, ________________________, Manager of the________________________ team in

the ____________________Division of State Park Little League, acknowledge that I have received the 2017 State Park Little League Safety Manual. I have read and understand the policies contained therein, and will uphold and execute stated policies..

Manager Signature _____________________________________ Date _______________

Name (printed) _________________________________________

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