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Confidential Complaint Form
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Who would you like to receive this complaint?
*
Select a recipient
Member Protection Officer (MPO)
President
MPO and President
Allegation/Issue
*
Select a category
Bullying
Discrimination
Harassment
Sexual Harassment
Assault
Sexual Assault
Other
Complainant Details
This section is OPTIONAL
Name of Complainant
Are you over the age of 18?
Please select an option
Yes
No
Phone number
Email
Role/status in club
Select a role
Administrator (volunteer)
Player
Coach/Assistant Coach
Employee (paid)
Official/Umpire
Parent
Spectator
Support Personnel
Other
Complaint details
Name of person/s subject to investigation
*
Are they over the age of 18?
Please select an option
Yes
No
Role/status in club
Select a role
Administrator (volunteer)
Player
Coach/Assistant Coach
Employee (paid)
Official/Umpire
Parent
Spectator
Support Personnel
Other
Description of Allegation/Issue
*
Provide details which are necessary for the Member Protection Officer’s investigation. Include witnesses (if appropriate), locations and timeline of events
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