Croquet Australia Complaint Form Survey

In line with Sports Integrity Australia, Croquet Australia has introduced a process for dealing with reports of inappropriate behaviours and disputes in croquet in an effective, appropriate and timely manner.

Please complete as much information as you can to assist with the process.

Further information regarding the complaints process can be found on the Croquet Australia website croquet-australia.com.au

Select the appropriate option(Required.)

Inappropriate/Prohibited Behaviour

Competition Related Dispute

Hazard/Potential Hazard

Personal Grievance

Other (please specify)

Details of person reporting the incident (Complainant).
Anonymous complaints many not be actioned.

Name

Phone

Email

Is the complainant over the age of 18?(Required.)

Yes

No

Name of the person being complainted about (Respondent)

Incident Details

Date of Incident

Time of Incident

Location of Incident

Description of alleged breach/incident by Respondent.
Please provide as much information as possible.

Enter details for any witnesses

Witness 1 Name

Email

Phone

Witness 2 Name

Email

Phone

Witness 3 Name

Email

Phone

Level of the Sport at which the alleged breach/incident occured

National (Croquet Australia) level where they relate to behaviours, incident or circumstance that occured at or invovle individuals operating at the national level

State level where they relate to behaviours, an incident or circumstance that occurred at or involve individuals operating at the State/Territory sporting association level

Affiliate level where it relates to behaviours, an incident or circumstance that occurred at or involve individuals operating at the Association/Club level

Policy that the Respondent has allegedly breached.

Member Protection Policy

Personal Grievance Policy

Other Policy (please specify)

Sections allegedly breached

1.

2.

3.

If this is a Personal Grievance complaint, what outcome are you seeking?

Does the Complainant consent to Alternate Dispute Resolution (mediation)?

Yes

No

Acknowledgement

I acknowlege that the information above it true and correct

Date of form completion