USA Rugby Safesport Reporting Form

USA Rugby Safe Sport Reporting Form
This form is for any member or affiliated person to submit a report of Harassment, Bullying, Hazing or Abuse, allegations of physical or emotional abuse related to rugby, or any potential violations of the USAR MAAPP.

If the report involved any sexual relationship, sexual abuse or sexual misconduct, the report should be submitted directly to US Center for SafeSport office HERE. Any questions about the process or program can be submitted to USA Rugby via safesport@usa.rugby
Reporting

YOU MAY REPORT ANONYMOUSLY. If you choose to report anonymously, please write ANONYMOUS where it says "Your full name."
Name

First NameLast Name
Your Position/Title/Affiliation
Phone Number

Area CodePhone Number
Email
example@example.com
Date of Complaint

MonthDayYear
Date
Did this incident violate the Minor Athlete Abuse Prevention Policy?

YesNo
Involved Parties

Please list the individuals involved, including as many of the listed fields as you can provide.The REPORTING PARTY is the person alleging a violation of the Code.The RESPONDING PARTY is the person who is alleged to have violated the Code.A THIRD PARTY REPORTER is a person who reports a possible violation of the Code, that is not the Reporting Party. A WITNESS is someone who saw or has personal knowledge of a possible violation of the Code.
Name

First NameLast Name
Gender
Select Role
Date of Birth

MonthDayYear
Date
Phone Number

Area CodePhone Number
Email
example@example.com
Team or Organization
Name

First NameLast Name
Gender
Select Role
Date of Birth

MonthDayYear
Date
Phone Number

Area CodePhone Number
Email
example@example.com
Team or Organization
Name

First NameLast Name
Gender
Select Role
Date of Birth

MonthDayYear
Date
Phone Number

Area CodePhone Number
Email
example@example.com
Team or Organization
Questions and Report
Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how).
If you are a Covered Adult (an individual over the age of 18 who is subject to SafeSport policies), you are also required to report all instances of possible child abuse and/or neglect to appropriate law enforcement. If you are uncertain whether you are a Covered Adult, review the policies and procedures at www.safesport.org or check with your sport National Governing Body. Does this case involve possible child abuse and/or neglect?

YesNoNot Sure
If so, have you reported to appropriate law enforcement authorities?

YesNo
Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 1GB maximum total size.Attachments require time to upload, so please be patient after submitting this form.
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USA Rugby Safe Sport Reporting Form

Reporting

Involved Parties

Questions and Report

Supporting Documentation