Safeguarding Report
This form is meant to provide the community with a safe space to report any misconduct within Rugby Americas North (RAN) activities and events. Should you or anyone else experience misconduct, please report as much details as you can in the report below. Your submission will be reviewed internally by RAN's Safeguarding Contacts and appropriate action and follow-up will be determined. Should you or anyone else be in a life-threatening situation, please contact your local authorities immediately. Any questions regarding safeguarding within RAN activities and events, please contact Erin Kennedy at ekennedy@rugbyamericasnorth.com.
Full Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Your Rugby Union (i.e. Jamaican Rugby Union, Rugby Canada, etc.)
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Email
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example@example.com
Incident Information
Please use this section to report as much information as possible about the incident or misconduct. Please report the Who, What, Where, When, Why, and How.
Incident Description
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Date of the Incident
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Month
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Day
Year
If the incident happened over multiple days, please indicate the start date, to your knowledge.
Involved Parties
Please list any other individuals that were involved in the incident and to what extent they were involved. (Include name, contact information, role in the incident, and other important information)
Was anyone involved in this incident under the age of 18 at the time of the incident?
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Yes
No
Unsure
Involved Parties
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Supporting Documentation
Please use this section to provide any supporting documentation or evidence.
Supporting Documentation
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Acknowledgement
I acknowledge that the information presented in this report is accurate to my knowledge. I am submitting this report with the intention of reporting misconduct and not for any other reason.
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I agree
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