BIR SafeSport Incident Report

SafeSport Incident Report
The completed form will be forwarded to the BIR Board President and Director of Programs and Business Development.

BIR strongly encourages the reporting of misconduct. BIR appreciates your willingness to report inappropriate behavior
When to Report:
Report here if you have experienced abuse or misconduct—or if you have reasonable suspicion of abuse or misconduct inflicted on, or by someone within our organization.

Anonymity:
Reports may be made anonymously. However, BIR encourages the complainant to provide enough detail to allow for a proper investigation if required.

Confidentiality:
All reports of misconduct are initially treated as confidential. The confidential nature of a report is maintained until the complainant determines that they wish the report to become a formal complaint. If a complainant requests, a confidential report may be provided to BIR strictly for inclusion in a case file without further action.
Today's Date

MonthDayYear
Date
SECTION I:
This section is about the individual you are reporting. Please provide as much information as possible.
Name of individual you are reporting:

First NameLast Name
Age or approximate age of Individual you are reporting:
Gender of offender
Position(s) this individual holds or held (please choose all that apply):

Head CoachAssistant CoachStaff MemberVolunteerOfficialOtherNot Sure
Club, team or organization where this individual works and/or volunteers currently or previously:
SECTION II:
This section asks questions about the incident or incidents you are reporting. Please provide as much specific information as you are able.
Type of Offense (i.e., what happened?):
Where did the incident or incidents take place? (City, State and any other available location information):
Please describe what happened (including who, what, when, where):
SECTION III:
This section is for information about the victim or victims. If you are the victim and wish to remain anonymous, you may do so. In that case, please enter only your age, city, state, and club affiliation.
Victim Name (you have the option to remain anonymous):

First NameLast Name
Age:
Club, team or affiliation (if any):
Gender: Male/Female/Other
SECTION IV:

Your Information
You may remain anonymous if you wish. However, providing your information is vastly helpful to a swift and effective investigation. A person reporting alleged misconduct should not fear any retribution and/or consequence when filing a report they believe to be true.
Your Name

First NameLast Name
Email
example@example.com
Club Affiliation
Relationship to victim (Please circle any that apply):

SelfParent/GuardianOther Family MemberFriend or acquaintanceClub member, coach or volunteerOther or prefer not to say
SECTION V: Other Information
If you have any other information that you feel would be helpful to an investigation of the alleged offense you have reported, please enter it here:
Should be Empty: