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AYSO Region 86 - Laguna Beach CA

Accident Report

Thank you for stepping forward to coach the players from Region 86 this season! You are the key figure in providing them with the fair, SAFE and positive environment in which they play.

In the case of injuries/accidents involving a player or coach while participating in an AYSO activity, it is the responsibility of the coach to report the incident in a timely manner. Proper reporting may allow the injured party to utilize the benefits of AYSO’s Soccer Accident Insurance (SAI) which can provide excess insurance coverage or possibly act as the “primary” provider of coverage if the injured party does not have other coverage.

Please fill out this “Incident Report” form specifically used for injury reporting during games or practices (or any incident that occurs at an AYSO sponsored event).  Please return the filled out form to the following Email addresses:  [email protected] and [email protected].

Best wishes for a successful and safe season!

Safety Director
Region 86


(Note: Coach/Asst. Coach should have the Player Registration forms at all scheduled practices and games. It is suggested that the coach copy a set of these forms for the Asst. Coach. In general, hospitals will only accept a copy of the Player Registration form, with an original parent’s (wet) signature, in case the player needs treatment as a result of an injury/accident and the original Player Registration form is not available).

Coaches need to be safety conscious and take pro-active corrective measures as needed to include the cancellation of an activity if unsafe conditions cannot be corrected. In these instances, the coach should also notify their Division Commissioner, the Regional Commissioner and the Regional Safety Director.

  1. In the case of injury or accident, the coach should limit their activity to basic first aid procedures. If additional medical attention is required, paramedics should be summoned by calling 911.
  2. The coach should report the injury/accident within 24 hours to the Regional Safety Director by email to [email protected]. The coach should also notify their Division Manager and the Regional Commissioner ([email protected]).
  3. In case of an injury/accident, the coach should complete the INCIDENT REPORT form within 24 hours and send it to the Region 86 Safety Director by Email and mail a physical copy to:

    AYSO Region 86, PMB 134
    ATTN: Safety Director
    303 Broadway, STE 104
    Laguna Beach, CA 92651

  4. Upon receipt of the INCIDENT REPORT form, the Regional Safety Director will provide the family with the appropriate information to initiate a Soccer Accident Insurance (SAI) claim. The Regional Safety Director will assist in verifying the player eligibility for coverage. It is the responsibility of the family (in the case of a player who has not reached majority age) or of the adult involved to follow the procedures of the carrier providing SAI coverage. A PARTICIPATION RELEASE form will also be provided.
  5. In order for the injured party to be eligible to return to practice(s)/game(s), the player’s parent or injured adult as well as their physician must complete the PARTICIPATION RELEASE form (if the injury/accident required medical attention) and return it to the Regional Safety Director as indicated above. Upon receipt and acceptance by the Regional Safety Director, the appropriate Division Commissioner will be notified.


The risk of contracting blood-borne diseases as a result of athletic activity is extremely minimal. In order to maximize the safety of the players, coaches, referees or others where blood may be present, it is to their advantage if the following AYSO guidelines are followed:

  1. The individual must leave the field immediately for treatment and may not return until the bleeding has stopped and the wound is covered.
  2. Blood on the body must be removed and the contaminated skin disinfected.
  3. Blood on clothing must be neutralized with a disinfectant or the clothing replaced.

AYSO also subscribes to the following Recommended Procedures from the NCAA Sports Medicine Handbook:

  1. Routinely use gloves when contact with blood or bodily fluids is anticipated.
  2. Immediately wash hands and other skin surfaces if contaminated with blood.
  3. Neutralize all blood contaminated surfaces with a freshly mixed disinfectant solution

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AYSO Region 86

303 Broadway STE 104, PMB 134
Laguna Beach, California 92651

Email Us: [email protected]
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