KEN BERRY LEAGUE

INCIDENT REPORT

DATE: ___________________  TIME: _____________            UMPIRE 1: _____________

                                                                                   UMPIRE 2: _____________

FIELD:     INSTRUCTIONAL (Boys & Girls)         BRANDT

              PARKINSON                                  BINKLEY (Midget)

              STALLARD (Minor)                         SCAMMON (Major)

              SHEETS                                       HAAG (Mini)

              LJUNGDAHL (Metro)

BOYS:   YES     NO            LEAGUE: _____________________________         

HOME TEAM: ______________________    VISITING TEAM: ______________________

GIRLS:   YES     NO            LEAGUE: _____________________________         

HOME TEAM: ______________________    VISITING TEAM: ______________________

BRIEF DESCRIPTION OF THE INCIDENT: ____________________________________

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PLAYER/COACH/SPECTATOR CAUSING THE PROBLEM: _____________________

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UMPIRE SIGNATURE: ___________________________________________________

BOARD MEMBER SIGNATURE: __________________________________________

WITNESS SIGNATURE: __________________________________________________

DIAGRAM OF THE INCIDENT:

                                                            2

                                             3                           1

                                                            H