POLICY – Member Protection Policy Part E- Reporting Forms

Policy Number xx-xxx – xxx

Document Control

Version Control

Date / Version / Details / Author

Approval

Delegation required for approval: Chief Executive Officer

Approving officer:

Name: ______Position: ______

Signature: ______Date: ______

Purpose and Background

Toassistinconsistencyandaccuracyinfollowingproceduresandreportingontheissuescoveredby <Insert Association>’s Member ProtectionPolicy,thefollowingdocumentsaretobeused:

ATTACHMENT E1 MPIO’sRecord ofComplaint

Tobeusedby MPIO’sorotherswho receive acomplaintorallegation.

ATTACHMENT E2 Confidential RecordofFormal Complaint

TobeusedwhenaformalcomplaintisreceivedbyNetballQueenslandoraRegion/Association/Club.

ATTACHMENT E3 Confidential RecordofChild AbuseAllegation

TobeusedbyMPIO’sorotherswhoreceive complaintcomplaints/allegationsof child abuse.

ATTACHMENT E4 Record of Mediation

Tobeusedbythosewhoconductmediation.

ATTACHMENT E5 Record of Tribunal Decision

ATTACHMENT E6 IncidentReportForm

ATTACHMENT E7 Applicationto Appeal Form

Generalprinciplestobe followedwhencompletinga report ofa complaint:

  • Treat all complaints seriously
  • Deal with complaints promptly,sensitivelyand confidentially
  • Maintain acalm attitude
  • Ask theComplainant ifthey will consent to youtakingnotes
  • Writethedescriptionofthecomplaint/problemusingtheComplainantsownwords(asmuchas ispossible)
  • FindoutthenatureoftherelationshipbetweentheComplainantandthepersoncomplained about (forexample, coach/competitor, team members, etc)andifthere isanyrelevanthistory
  • Takea note of thefactsand donotpre-judgethesituation
  • Ask theComplainant whether theyfearvictimisationorotherconsequences
  • Findoutwhatoutcome theComplainantwantsandiftheyneedanysupport
  • Ask theComplainant howtheywanttothecomplainttobedealtwith under thePolicy
  • Keep the complaint confidential and do not disclose it to another person without the Complainant’sconsentexceptifdisclosureisrequiredby law (forexample,areportto governmentauthorities) orifdisclosureisnecessaryto effectivelydealwith thecomplaint

ATTACHMENT E1: MPIO’s Record of Complaint

Nameof MPIO: / Date: / /
Complainant’sName: / Over18 Under18
Role/statusinnetball: /  Administrator(volunteer)  Parent
 Athlete/player Spectator
 Coach/AssistantCoach  SupportPersonnel
 Employee(paid)  Other
 Official ……………………………….…….…….
……………………………………..……
Location/eventof alleged issue:
Factsasstatedby complainant:
Natureof complaint:
(category/basis/grounds)
Cantickmorethanone box /  Harassment OR  Discrimination
 Sexual/Sexist SelectionDispute
 Sexuality PersonalityClash
 Race  Bullying
 Religion  VerbalAbuse
 Pregnancy PhysicalAbuse
 Disability Victimisation
 ChildAbuse
 Other…………………………………………………………………………………
Feelingsexpressedby complainant:
(completing thismay helpto separateemotionalcontent fromfacts)
Whattheywantto happentofixthe issue:
Whatinformationis provided:
Whattheyaregoingto donow:

Thisrecordandanynotesmustbekeptinaconfidentialplace–donotenteritonacomputersystem. Iftheissue becomesa formalcomplaint, thisrecordis tobe sent to the MPIO/relevantpersonnelof Netball Queenslandor Region/Association(whateverlevel thecomplaint was made).

ATTACHEMENT E2:Confidential Record of Formal Complaint

Complainant’sName: / Over18 Under18 / DateFormalComplaint
Received: / /
Role/statusinnetball: /  Administrator(volunteer)  Parent
 Athlete/player Spectator
 Coach/AssistantCoach  SupportPersonnel
 Employee(paid)  Other
 Official ……………………………….…….…….
……………………………………..……
Nameof Respondent:
IstheRespondenta financialmemberof NetballQueensland? / Over18 Under18
Yes No
Role/statusinnetball: /  Administrator(volunteer)  Parent
 Athlete/player Spectator
 Coach/AssistantCoach  SupportPersonnel
 Employee(paid)  Other
 Official ……………………………….…….…….
……………………………………..……
Location/eventof alleged issue:
Descriptionofalleged issue:
Natureof complaint:
(basis/grounds/category)
Cantickmorethanone box /  Harassment OR  Discrimination
 Sexual/Sexist SelectionDispute
 Sexuality PersonalityClash
 Race  Bullying
 Religion  VerbalAbuse
 Pregnancy PhysicalAbuse
 Disability Victimisation
 ChildAbuse
 Other…………………………………………………………………………………
Methods(if any)of attemptedinformal resolution:
Supportperson(if any):
Formalresolution proceduresfollowed:
(outline)
Ifinvestigated:Finding-
Ifwenttohearing tribunal:
Decision-
Actionrecommended-
Ifmediated:
Dateofmediation- Werebothparties
present-
Termsof Agreement-
Anyotheractiontaken-
Ifwenttoappeals tribunal:
Decision-
Actionrecommended-
Resolution: /  Lessthan3monthstoresolve
 Between3 –8monthstoresolve
 Morethan8monthstoresolve
Completedby: / Name:
PositioninNetballQueensland/Region/Association:
Signature: / /
Signedby: / Complainant:
Respondent:

Thisrecordand anynotes mustbekeptin aconfidential place. Ifthecomplaintisofa seriousnature,or isescalatedtoand/ordealtwithatthenextlevel,theoriginalmustbeforwardedto thehigherbody(i.e. NetballQueensland)andacopy keptattheNetballQueenslandorRegion/Association/Club level(whateverlevel thecomplaintwas made).

ATTACHTMENT E3:Confidential Record of Child Abuse Allegation

Beforecompleting,ensure theproceduresoutlinedinAttachmentC4oftheNetball QueenslandMember Protection Policy– PartC (ComplaintHandlingPolicy)havebeen followedandadvicehasbeensoughtfromtherelevant governmentagencyand/orpolice.

Complainant’sName:
(ifotherthanthechild) / DateFormalComplaint
Received: / /
Role/statusinnetball:
Child’sname: / Age:
Child’saddress:
Person’sreasonfor
suspectingabuse:
(e.g.observation, injury, disclosure)
Nameof Respondent:
IstheRespondenta financialmemberof NetballQueensland? / Yes No
Role/statusinnetball: /  Administrator(volunteer)  Parent
 Athlete/player Spectator
 Coach/AssistantCoach  SupportPersonnel
 Employee(paid)  Other
 Official ……………………………….…….…….
……………………………………..……
Witnesses:
(if morethan3witnesses, attachdetails tothis form) / Name(1): Contactdetails: Name(2): Contactdetails: Name(3): Contactdetails:
Interimaction(if any)
taken:
(toensurechild’s safety and/or tosupportneeds of person complainedabout)
Policecontacted: / Who: When:
Adviceprovided:
Governmentagency contacted: / Who: When:
Adviceprovided:
Region/Association
PresidentorSecretaryor
GMcontacted: / Who: When:
Policeand/or governmentagency investigation: / Finding:
Internalinvestigation:
(ifany) / Finding:
Actiontaken:
Completedby: / Name:
PositioninNetballQueensland/Region/Association:
Signature: / /
Signedby: / Complainant:(ifnotachild)

Thisrecordandanynotesmustbekeptinaconfidentialplaceandprovidedtotherelevantauthorities(police andgovernment)should theyrequirethem.

ATTACHMENT E4: Record of Mediation

PresentatMediation:
Dateofmediation:
Venueofmediation:
Mediator:
Summaryofmediation:
(minutesattached)
Outcomeofmediation:
Follow-uptooccur:(ifrequired)
Completedby:
(signature)
Signedby: Complainant:(signature)
Respondent:(signature)

Thisrecordandanynotes must bekeptina confidential place.Acopyshould be retained by Netball

Queenslandand/orRegion/Association (whateverlevel thecomplaintwas made).

ATTACHMENT E5:Record of Hearings Tribunal Decision

Complainant’sName: / DateFormalComplaint
Received: / /
Role/statusinnetball: /  Administrator(volunteer)  Parent
 Athlete/player Spectator
 Coach/AssistantCoach  SupportPersonnel
 Employee(paid)  Other
 Official ……………………………….…….…….
……………………………………..……
Nameof Respondent:
Role/statusinnetball: /  Administrator(volunteer)  Parent
 Athlete/player Spectator
 Coach/AssistantCoach  SupportPersonnel
 Employee(paid)  Other
 Official ……………………………….…….…….
………………………………………….
Location/eventof alleged issue:
Descriptionof alleged issue:
Natureof complaint:
(basis/grounds/category)
Cantickmorethan1 box. /  Harassment OR  Discrimination
 Sexual/Sexist SelectionDispute
 Sexuality PersonalityClash
 Race  Bullying
 Religion  VerbalAbuse
 Pregnancy PhysicalAbuse
 Disability Victimisation
 ChildAbuse
 Other……………………………………………………………………………………
Methods(ifany)of attemptedinformal resolution:
Supportperson:(ifany)
HearingsTribunal
Members:
HearingsTribunalDate and venue:
HearingsTribunal
Decision:
(attachreport)
Actionrecommended andanyfollowupreport required:
DecisionAppealed: Dateof Appeallodged:
AppealHearingDate:
AppealDecision:
(attachreport)
ActionRecommended:
Completedby: / Name:
PositioninNetballQueensland/Region/Association:
Signature: / /
Signedby: / Complainant: Respondent:

Thisrecordandanynotesmustbekeptinaconfidentialplace.AcopyshouldberetainedbyNetballQueenslandand/orRegion/ Association(whateverlevel thecomplaintwas made).

ATTACHMENT E6:Incident Report Form

Thisreportsheetistobecompletedonincidentsoccurring withinacompetitionandmustbe lodged with the relevant official of Netball Queensland or the Region/Association in accordancewiththe specifiedtimeframes.

Date: ______Competition:______Division:______

Teams:______V ______

If theincidentisregardingthe conductofaplayer,pleasecompletethe following:

Offending Players Team: ______

Offending Players Position: ______

Offending Players Name: ______

If theincidentisregardingthe conductofany otherperson, pleasecompletethefollowing:

Persons Name: ______Persons District: ______

CHARGE:

Please tick appropriate offence. If more than one offence, tick all appropriate boxes.

 / Fighting/ striking withaclenchedfist. /  / Using abusive, obscene and/or threatening language.
 / Strikingwithanopenhand. /  / Strikingwithaball orotherobject.
 / Kicking/ attempting tokick. /  / Deliberatelytrippinganopponent.
 / Attempting tostrikewithaclenchedfist. /  / Deliberately elbowing.
 / Racial /discriminatoryabuse. /  / Undue rough play.
 / Unsportingconduct,includingdisputing decisions. /  / Repeateddeliberate infringements.

Pleaseanswerthefollowing:

1. Wasawarninggiven totheplayerduring thegame? Yes No

2. Wastheplayersuspendedforaspecifiedperiodduring thegame? Yes No

Ifyesforhowlong? (e.g.3 centres,1interval)

3. Wasthe playerorderedoff(whole game)? Yes No

4. Wastheplayerabusive towards theOfficial(s) after thegame? Yes No

5. Ifthematteris referredto aDisciplinaryHearing, you maybe required toappearandgive evidence.Willthis cause difficultyforyou? Yes No

Pleasegivespecificsoftheoffence(includewordforwordverbalsorswearing)andlistany witness/witnesses.

______

Name: ______Signature: ______

Contact Information: ______

Signature of Netball Queensland and/or Region/Association Official: ______

Date: ______Time: ______

Netball Queensland and/or Region/Association/Club Official Use:

______

______

ATTACHMENT E7:Application to Appeal Form

Appellant Information

InformationcontainedintheApplicationtoAppealFormmustbecompletedinBLOCKletters.Please complete ALLfields.

Contact Details

Association Name: ______

Contact Person: ______

Official Position: ______

Address: ______

Postal Address: ______

Telephone (b/h): ______

Telephone (a/h): ______

Mobile: ______

Fax: ______

Email: ______

1. Theappellantappealspursuantto(insertsectionandtitleofConstitution,By-Laws,CompetitionRules, administrative decisionetcunder whichappealis brought):

______

2. From a (state whether a decision, order, refusal etc is appealed against)

______

3. By (insert name of person or committee appealed against):

______

4. On (insert date of decision etc appealed against):

______

5. Matters appealed against are (setoutbriefdescriptionofmattersappealed,includingwhethertheappealis againstthewholedecision,orpart ofadecision,andifapart which partor parts ofthe decision):

______

6. Groundsoftheappealare(setoutfullythegroundsofappealinnumberedparagraphs–ifinsufficientspace the grounds ofappealshouldbe includedasanattachment):

______

7. Namesofwitnessesandrepresentatives(includecontacttelephonenumbersofpeoplewhoaretoprovide informationonyour behalftotheAppealsCommittee):

______

8. Thefollowingdocumentsareattachedinsupportoftheappeal(setoutdocuments,includingtitleand dates):

______

9. Outcomerequested(setouttheoutcomesought or inwhichwayit isclaimedthematter appealed againstshould bevaried):

______

Signature: ______

Capacity: ______

Related Documents

Netball Queensland Member Protection Policy

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