INCIDENT REPORT FORM

Incident Report and Secondary Sports Accident Insurance Procedures

Here outlines the procedures for Great Plains Incident Reports and medical claims should the participant have out of pocket expenses due to injury at a USAV/Great Plains sanctioned event.

Should an injury occur at a sanctioned USAV/Great Plains Region event. This could include tournaments, practices, or clinics but must be sanctioned.

  • An Incident Report form should be completed ON SITE at the time of injury. It should be signed by the Regional Contact, Event operator, Coach, or USAV staff member and Medical Personnel who were present at the time (if applicable).  
  • Send Incident Report form to Region Office
    (email: membership@gpvb.org or Fax: 402-593-9760)
    • Submitting an Incident Report form does NOT initiate a Medical Claim
  • The Region will submit the Incident Report form to USA Volleyball.
  • In the case that a Medical Claim needs to be filed, the injured party/parent will need to complete the Medical Claim form and email it to: claims@agadm.com

The Insurance company will then work with the individual to reimburse them for any expenses the insurance will cover.  There may be a deductible on the coverage.

Any questions regarding these procedures can be sent to the Region Office.

ACCESS INCIDENT REPORT FORM HERE

MEDICAL CLAIM FORM

In the case that a Medical Claim needs to be filed, the injured party/parent will need to complete the Medical Claim form and email it to: claims@agadm.com

  • Should be completed whenever claim results from an injury incurred at USAV sanctioned events.
  • Should be completed after you receive the medical bills.  
  • Make a copy for your record.

ACCESS MEDICAL CLAIM FORM HERE

SafeSport - Reporting Abuse

CRITICAL INFORMATION FOR ALL GREAT PLAINS MEMBERS
The Great Plains Region and USA Volleyball is committed to the safety of all participants. Both entities have ZERO TOLERANCE for abuse and misconduct.

This includes not only on-court safety, but also off-court safety in any part of USA Volleyball’s programs. USA Volleyball is committed to creating safe and fun environments for youth. This includes, but not limited to, providing training, educational materials, and resources for our regions, clubs, coaches, parents, and athletes. 

REPORTING CHILD ABUSE FORM

When or How Should I Make a Report?

USA Volleyball requires the reporting of sexual misconduct by or of any member and strongly encourages reporting of any concerns related to SafeSport. Please read over the Report Abuse Information to fill out a Report Abuse Form.

CALL 1-855-306-7775 TO REPORT ABUSE