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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.

The Regional Safety Director should supply coaches with several copies of the form at the beginning of the season.

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 should be instructed to submit Incident Report Forms to the Regional Safety Director.

Incident Report Form

Incident Report Form (Example)

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

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Contact Us

Region 75 Whittier

PO Box 5463 
Whittier, California 90607

Email Us: [email protected]
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