Complaints

Full Name (The Reporter)*

Preferred Contact Number

Email*

Postcode*

Do you identify as Aboriginal or Torres Strait Islander?*

Do you identify as a person with a disability?

Is English your first language?

Your role/position within basketball?

Are you submitting a Report on behalf of someone else?*

Please provide the following details about the person you are acting on behalf of. Be aware if you are not the legal guardian (for example, the parent of a person under 18) or legal representative for this person, we may need to contact this person to seek their approval for you to act on their behalf.

Full name of the person or organisation*

If unknown, please provide any names they are known by or enter ‘Unknown’

Person’s role or position

You can choose more than one.

The person's relationship to you or the person you are submitting the form on behalf of?

Alleged Prohibited Conduct by the person

Please just select the Prohibited Conduct which is most relevant to the conduct of the person. You can choose more than one.

Description of the alleged Prohibited Conduct*

Provide as much information as possible, including details about who was involved, what happened and/or how you found out about the alleged Prohibited Conduct. If you included the details of more than one person and/or person the Prohibited Conduct happened to above, ensure you include names when you explain how each person was involved and what happened to each person.

Was another person involved in this alleged Prohibited Conduct?

Prohibited Conduct can be carried out by more than one person.

Date/s of alleged Prohibited Conduct by the person(s)*

Location and address (if known) where the alleged Prohibited Conduct occurred*

Witnesses (if any)

Have you previously complained about or reported the alleged conduct to another organisation, body or agency?*

For example, to an association, a law enforcement agency, or an anti-discrimination or equal opportunity agency?

Declaration confirmation*

I acknowledge that this Report may not be managed through Shellharbour City Basketball's complaint handling process and, as a result, there may not be any follow-up from Shellharbour City Basketball in relation to my Report. De-identified information you provide in your Report may be used to understand trends and patterns of issues that may be present within the club. Shellharbour City Basketball will use this information to better understand the nature of integrity issues in our community and to support the development of programs to prevent and better respond to integrity threats in basketball.