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.
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 ([email protected]) and copy the Regional Commissioner ([email protected]).
Download Incident Report Form
Soccer Accident Insurance
AYSO purchases Soccer Accident Insurance (“SAI”), which pays excess medical costs up to $50,000 maximum per accident to an insured person for accidental bodily injuries incurred as a direct result of participation in a covered activity subject to the policy terms, conditions and exclusions. Eligibility for benefits is 52 weeks from the date of a covered accident. See the Maximum Benefits Payable listed below for a more detailed explanation of the plan limits. Accident Medical Expense Benefits are only payable:
- For usual and customary charges incurred after the deductible has been met;
- For those medically necessary covered expenses that the covered person receives;
- If first medical or dental expense must be incurred within 60 days of covered accident;
- Proof of loss is filed within 90 days;
- Each claim is subject to a $500 Deductible; and 20% member Coinsurance;
For questions or claims, please reach out to the Regional Commissioner ([email protected]).