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Welcome to Region 75 Celebrating 50 Years Serving Whittier - Santa Fe Springs - Norwalk

SAFETY INCIDENT REPORT

                    

AYSO INCIDENT REPORT FORM INFORMATION

The purpose of the AYSO Incident Report Form is to capture all pertinent facts and contact information, while the information is readily available, whenever there is a serious incident involving AYSO participants, activities, facilities or property. Please click the link below.

The Regional Safety Director is responsible for educating Regional staff, board members, coaches, referees and other volunteers about the importance of completing the AYSO Incident Report Forms. The Regional Safety Director is also responsible for distributing, collecting, and storing the forms; and for reporting incidents to the AYSO National Office.

Incident Report Forms should be completed by any coach, referee or Regional staff member witnessing any serious incident involving, but not limited to:

• Injuries
• Illnesses
• Threats of bodily harm
• Fighting whether or not a serious injury occurs
• Property damage
• Hospitalization of a participant
• Law enforcement summoned
• Service or notification of a pending lawsuit

Regional staff, coaches, and referees please submit Incident Report Forms to the Regional Safety Director. Below is a link to the incident report, please review the example report to ensure that the report is filled out correctly. Only submit the report to the Regional Safety Director at the email supplied below!

Incident Report Form

Incident Report Form (Example)

Submit your complete Incident Report to our Safety Director (Lisa M.) at 
[email protected]

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Contact Us

AYSO Region 75 Whittier - Santa Fe Springs - Norwalk

PO Box 5463 
Whittier, California 90607

Email Us: [email protected]
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