Part E - E2: Confidential record of formal complaint

PART E: REPORTING DOCUMENTS AND FORMS

E2: CONFIDENTIAL RECORD OF FORMAL COMPLAINT

Date formal complaint made:

Full name of Complainant:

Over 18-years

Under 18-years

Complainant’s role / position in Sport:

Administrator Parent Athlete / Player

Spectator Coaching Staff Support Staff

Official Employee (Paid) Volunteer (Unpaid)

Other

Full name of person complained about?

Over 18-years

Under 18-years

Role / status in sport of person complained about?:

Administrator Athlete / Player Parent / Guardian

Spectator Coaching Staff Support Staff

Employee (Paid) Volunteer (Unpaid) Official

Other

Event and location of alleged issue:

Description of alleged issue:

Nature of complaint (tick as many boxes as required):

Harassment (category) Discrimination (category) Sexual / Sexist

Race Religion Pregnancy

Disability Child Abuse Personality Clash

Bullying Verbal Abuse Physical Abuse

Victimisation Other

Method (if any) of attempted informal resolution:

Support person (if any):

Formal resolution procedures followed (outline):

Findings of any investigations:

Decision of any hearing tribunal:

Action recommended:

Date of any mediation

Were both parties present?

Yes

Terms of agreement at mediation:

Other action taken at mediation:

Decision from any appeals tribunal:

Action recommended at appeals tribunal:

Resolution – how long to resolve:

Less than 3 months Between 3 to 8 months More than 8 months

Completed by:
Full Name:

Title / Position:

Organisation:

Signature:					Date:

Signed by:
Complainant:

Respondent:

This record and any notes must be kept in a confidential place. If the complaint is of a serious nature, or is escalated to and / or dealt with at the national level, the original must be forwarded to the national body and a copy kept at the club / state / district level (whatever level the complaint was made).