USA Climbing Reporting Form

USA Climbing strongly encourages the reporting of misconduct and appreciates your willingness to report inappropriate behavior. USA Climbing will maintain confidentiality to the extent possible by law. Please provide as much specific information as possible, with the understanding that you may not have information in response to every question.

Please provide as much information about yourself as you are willing. While you can leave sections blank or report anonymously, this could prevent us from getting information we need.

There are no associated costs, fees, or other financial barriers to submit a report. If you have any questions, please email athletesafety@usaclimbing.org

1. Reporter's Full Name

2. Reporter's Email Address

example@example.com

3. Reporter's Phone Number

4. Reporter's Gym or Team Affiliation (if any)

Please provide as much information about the person you are reporting. We refer to the person that has allegedly committed misconduct as a respondent.

5. Full name of the respondent

6. City/State of the respondent

7. Phone number of the respondent

8. Email address of the respondent

example@example.com

9. Age of the respondent

10. Position or role of the respondent (for example: coach, gym employee, athlete, etc.)

11. Gym/team affiliation of the respondent

Please provide as much information about the person that was allegedly a victim of misconduct. We refer to the person that was allegedly a victim of misconduct as a claimant.

12. Full name of the claimant

13. City/State of the claimant

14. Phone number of the claimant

15. Email address of the claimant

example@example.com

16. Age of the claimant

18. Gym/team affiliation of the claimant

In this section you will provide details of the alleged misconduct. Please provide as much detail as possible.

19. Please describe what happened; this should be as detailed as possible

20. When did the incident occur? (while this should be as detailed as possible, approximate dates are okay as long as it is noted)

21. Where did the incident occur?

22. Please list additional witness names and contact information

23. Please use this space to provide any additional information regarding this incident