USA Baseball SafeSport Reporting Form

Incident Reporting Form
By submitting this form, you are giving permission to USA Baseball Athlete Safety staff to contact you with regard to the alleged incident, and authorizing USA Baseball to share all information you provide with law enforcement authorities and other organizations at its sole discretion. The information you submit will also be used and shared as set forth in our Privacy Policy. .

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USA Baseball encourages honest and effective reporting; knowingly making a false or vindictive report is unethical and will not be tolerated, and may be a violation of federal law.

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All adults working with minor athletes are mandatory reporters under federal law, and if the law enforcement authorities have not yet been contacted, they should be contacted immediately.

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If you are under the age of 13 and need to make a report to USA Baseball regarding an incident of abuse, please dial 919.474.8721 extension 211.
Required Information
First Name of person reporting incident*
Preferred way to contact you?*

E-mailPhone
E-mail of person reporting incident
Phone of person reporting incident
Type of Incident*
Date of Incident*

MonthDay Year
Date
Location of Incident*
If there are multiple dates/locations, please put them in the description box below.
Please describe the incident. Please provide as much specific information as you are able.*

0/1000
Minor Athlete's Information
If you are the victim and wish to remain anonymous, you may do so. In that case please enter your name as Anonymous.

You may also be unaware of who the victim is. In that case, please enter Unknown.
Athlete's Name

First Last
Age or Approximate Age
Gender
Organization/Club Affiliation
Whereabouts of minor athlete, if known
Additional Information

If additional minor athlete's are involved, or you have additional information to share.0/1000
Minor Athlete's Parent or Guardian Information
Name of Parent or Guardian

First Last
Parent Or Guardian

ParentGuardianNot Provided
Phone Number
Email
example@example.com
Street Address

Street Address Line 2

City State

Zip Code
Additional Information
Additional information on person reporting incident
Last Name of person reporting incident
Street Address

Street Address Line 2

City State

Zip Code
Additional information on incident
Reported to Authorities

YesNo
Name of legal authority
Date reported to legal authorities

MonthDay Year
Date
Additional Information

List anyone who may be able to provide additionalinformation regarding the alleged offense. We will not identify you when we contact these individuals.0/1000
Enter the message as it's shown*
Should be Empty:

Incident Reporting Form

Required Information

Minor Athlete's Information

Minor Athlete's Parent or Guardian Information

Additional Information

Additional information on incident