SARATOGA CONTINENTALS FC

Incident / Injury / Safeguarding Report

Operational record — do not delay emergency or mandatory reporting while completing this form.

Emergency or suspected abuse: If someone is in immediate danger, call 911. If child abuse or sexual misconduct is suspected, make any report required by law or applicable governing-body policy promptly. A club report is not a substitute for a legally required external report.

1. Basic Information

Date / time Location Person completing report Role Person(s) involved Witnesses

2. Type of Incident

☐ Injury / medical☐ Concussion concern☐ Bullying / harassment☐ Boundary / safeguarding concern☐ Suspected abuse / misconduct☐ Facility / equipment issue☐ Other

3. Objective Description

Record facts, observations, exact words when important, and actions taken. Avoid speculation or diagnosis.

4. Immediate Actions

☐ Player removed from activity☐ First aid / EMS☐ 911 called☐ Parent/guardian notified☐ Law enforcement / child-protection report made where required☐ Governing body / SafeSport report made where applicable

Agency / report reference Time notified

5. Follow-up

Signature Date Reviewed by Date