Impact Gold Concern Reporting Form

Impact Gold Concern Reporting Form

Use this form to share a concern about conduct, safety, or treatment within Impact Gold Fastpitch. Share what you know, even if some details are incomplete. You may leave your name and contact information blank. Good-faith reporting is protected from retaliation. Information may be shared when needed for safety, appropriate review, or legally required reporting. Details in your report may still identify the people involved.

If someone is in immediate danger or needs emergency assistance, call 911. This form is not an emergency response service. Do not wait for a response before seeking urgent help or making required reports to child protection authorities, law enforcement, or another designated authority. Coaches must notify organization leadership immediately about abuse concerns. The 24-hour cooling-off rule does not apply to abuse reports.
Immediate Safety and Type of Concern
Is anyone in immediate danger or in need of urgent medical attention? ( If someone is in immediate danger or needs emergency assistance, call 911.)
What type of concern would you like to report?
About You
What is your connection to Impact Gold?

Other
Are you under 18?
Would you like to provide contact information so we can follow up with you?
Your name or preferred name
Preferred contact method
Safe email address
example@example.com
Safe phone number
Please enter a valid phone number.Format: (000) 000-0000.
Is it safe to leave a voicemail?
Trusted adult's name and relationship
Optional: name and relationship of a trusted adult you would like to help you communicate.
Is there anything we should know about contacting you safely?
Is there a trusted adult you would like to help you communicate about this report?
Safe contact details for that trusted adult
Who the Concern Involves
Team name
Enter Organization-wide or Not sure if applicable.
Age division
Enter Organization-wide or Not sure if applicable.
Area or region
Enter Organization-wide or Not sure if applicable.
Who does your concern involve?
Names, roles, and teams of the people involved, if known
Is anyone who normally receives or reviews concerns involved in this situation?
Please identify the person or people, if known, and explain their involvement.
What Happened
Please describe your concern in your own words.
How did you learn about this concern?
Who has been affected by this situation?
Names or roles of those affected, if known
Does this involve anyone under 18?
Has this happened more than once, or is there concern about further contact?
Additional details or the date of an upcoming activity, if relevant
Other Information That May Help
Is there anyone else who may have relevant information?
Have you already shared this concern with anyone?
Date or approximate date
Enter an approximate date or Not sure.
Approximate time, if known
Approximate time or Not sure.
Location, event, or team activity
City and state, if relevant
Online platform or communication channel, if applicable
Supporting materials (optional). Do not delay reporting to gather evidence. Do not upload sexual images or videos, or unrelated sensitive personal records.

Cancelof
Relevant links or a brief description of other materials
Who did you contact, approximately when, and what response or action, if any, followed?
Support and Acknowledgment
Are you concerned about retaliation or about someone being contacted because of this report?
What are you concerned might happen? Is there anyone we should consider carefully before contacting because it could affect someone's safety?
What support or next step would be helpful to you?

Something else
Anything else you would like us to understand or consider
I am sharing this concern honestly and in good faith, based on what I know or have been told. I understand that I do not need proof to raise a concern.
Should be Empty:

Impact Gold Concern Reporting Form

Immediate Safety and Type of Concern

About You

Who the Concern Involves

What Happened

Other Information That May Help

Support and Acknowledgment