Report Form

Report Form
If you are in Australia and in immediate danger or at risk of harm, call your local law enforcement agency or dial triple zero (000).

If you or any person involved in the process requires support, please see the information below.

Black Dog Institute (02) 9382 4530 | blackdoginstitute.org.au
Lifeline 13 11 14 | lifeline.org.au
Beyond Blue 1300 22 4636 | beyondblue.org.au
Headspace | headspace.org.au
Reports of a incident can be anonymous. This form is merely for feedback and intelligence gathering purposes only.

If you wish to lodge a formal complaint about an incident please proceed with the Complaint form found here.
1. Contact Details

This section can be left blank
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
How do you identify?

AthleteParent / guardian (for athletes & members under 18)CoachRegistered Gym/Club with a Member AssociationAdministrator (referee, judge, volunteer etc)Member (registered with a Member Association)Other
If you have selected 'Other' above please provide connection to Boxing Australia/or its Member Association?
2. Reporting Information

Please provide accurate and factual information when reporting.
What is the nature of your report?

Member ProtectionChild SafetyHigh PerformanceGym MisconductBA/or MA MisconductHarrassmentDiscriminationBullyingOther
If you have selected 'Other' above please provide nature of the report?
When did the incident take place? (if applicable):

MonthDayYear
Date
Which person or organisation is the report about?
Please provide a detailed account of your report. Include the names and contact information of any other parties involved.
Which BA regulations and/or policy do you believe have been violated in the incident described?
Please ensure you reference name of policy and what specific clause. This can be found on Boxing Australia's website.
What steps (if any) have you taken to resolve this matter?
Have you reported this to your Member Association for action?*

YesNo
3. Declaration
I hereby declare that the information provided is true and correct. I understand that providing false or misleading information may delay or prevent any investigation by Boxing Australia.
I hereby declare that the information provided is true and correct. I understand that providing false or misleading information may delay or prevent any investigation by Boxing Australia.*

Yes
Date*

MonthDayYear
Date
Submit your report

Your submission is sent to the BAL Integrity Manager. All submissions are strictly confidential.
Should be Empty:

Report Form

1. Contact Details

2. Reporting Information

3. Declaration

Submit your report