Please fill out the following details to report a breach of integrity or an incident of harassment, abuse or any other threatening or concerning behaviours

Fields marked with * are mandatory

Note: All information provided will be treated confidentially

-----------------

1. Tick the box below which best describes the issue you are reporting:*

Harassment or AbuseDopingCompetition ManipulationOther

2. Details of person filing the report (You):

Name*

Date and time of completing form*

Address*

Mobile number*

Email*

3. Details of incident (what do you know):*

4. Details of alleged victim(s) if known:

If you are the victim, please fill out 'name' in this section, then skip to question 5
Name

Address

Mobile number

Email address

Age

5. Did you witness the incident?

Did you witness the incident?*

6.Third party details - if applicable

Were you informed by a third party?*

If yes, please provide their details:
Name

Address

Mobile number

Email address

7. Other details:

If you spoke to the alleged victim what did they say?* (Do not interview them but do record what they said)

What action did you take?*

Who was notified?* - Where there is risk of immediate harm the police should be informed

Details of any other persons who were told of the incident, or witnessed the incident...*

Any other information?

Do not investigate or carry out any further action unless there is an immediate risk of harm to a person.

Do not discuss with anybody who does not need to know about this allegation.

This document needs to be completed accurately with the information you know.

I believe the information I have provided is true to the best of my knowledge and understand that this document may be disclosed to relevant law enforcement or other agencies who have a responsibility to investigate these matters.*

I confirm that the statement above is true

Δ