SAFEGUARDING – REPORT AN ISSUE – Badminton Cook Islands

1. Which of the following best describes the issue you are reporting?Harassment or Abuse? Doping? Competition Manipulation? Other?

2. Details of person filing the report (you)Name(required)

Date and time of completing form(required)

Address(required)

Mobile Number(required)

Email(required)

3. Details of incident (what do you know)?(required)

4. Details of alleged victim(s) if knownName

Address

Mobile Number

Age

5. Did you witness the incident?(required)

6. Third party details – if applicableWere you informed by a third party?(required)

If so, please provide their details:Name

Address

Mobile number

7. Other details:If you spoke to the alleged victim, what did they say? (Do not interview them but do record what they say)(required)

What action did you take?(required)

Who was notified? – Where there is risk of immediate harm, the police should be informed(required)

Details of any other persons who were told of the incident, or witnessed the incident…(required)

Any other information?