Safeguarding Report

Safeguarding Report

This form is meant to provide our Girls Rugby community with a safe space to report any misconduct, abuse, incidents, etc. If the incident or information pertains to something within Girls Rugby activities/events (e.g. abuse from a coach), it can be reported directly through SafeSport. If the incident or information pertains to something outside of Girls Rugby (e.g. abuse at home, concern of self harm, etc.), use this form and someone will follow up with appropriate next steps. All information submitted will be kept confidential. Your submission will be reviewed internally by Girls Rugby 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 with Girls Rugby, please contact Girls Rugby at info@girlsrugbyinc.com.
Your Full Name (Person making the report) *

First Name Last Name
Your Email *
example@example.com
Your Phone Number *
This will only be used for follow-up to acquire more information if it is needed.
What is your primary role with Girls Rugby? *

Coach Referee Other Volunteer (Role different from a coach/referee) Program Coordinator/Program Manager Parent/Guardian Other
If you answered 'Other' above, please indicate your role:
Situation/Incident Information

Please be as detailed as possible with the information you provide below. All information will be kept confidential and used only to take the appropriate next steps. Please report the Who, What, Where, When, Why, and How.
Describe what happened... *
Date of the Incident/Situation *

Month Day Year
If the incident happened over multiple days, please indicate the start date, to your knowledge.
Describe your response... What did you do? How did you react? *
However you responded to the situation is fine. This information just helps us to know what happened before, during, and after.
Involved Parties

This information is not required at this time, but please know that we may follow up and ask for this information. Remember that everything is confidential and will not be shared. 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)
Please list any involved parties here (e.g. victims, abusers, witnesses, etc.)
Supporting Documentation

Please use this space to upload any supporting documentation or evidence that will support your report. This can include communication exchanges like screenshots of text messages or emails, photographs of any signs of abuse, written submissions from victims or witnesses, etc.
File Upload

Cancel of
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 abuse/misconduct and not for any other reason *

I agree
Should be Empty:

Safeguarding Report

Situation/Incident Information

Involved Parties

Supporting Documentation

Acknowledgement