ATTACHTMENT E3: Confidential Record of Child Abuse Allegation Before completing, ensure the procedures outlined in Attachment C4 of the Insert Association Name Member Protection Policy Part G (Complaint Handling Policy) have been followed and – advice has been sought from the relevant government agency and/or police. Complainant’s Name: Date Formal Complaint Received: / / (if other than the child) Role/status in netball: Child’s name: Age: address: Person’s reason for suspecting abuse: (e.g. observation, injury, disclosure) Name of Respondent: Is the Respondent a   Yes No financial member of  Insert Association Unknown Name? Role/status in netball:   Administrator (volunteer) Parent   Athlete/player Spectator   Coach Support Personnel   Employee (paid) Other  Official ……………………………….…….……. ……………………………………..…… Witnesses: Name (1): (if more than 3 witnesses, Contact details: attach details to this form) Name (2): Contact details: Name (3): Contact details: Interim action (if any) taken: (to ensure child’s safety and/or to support needs of person complained about) Police contacted: Who: When: Advice provided:
ATTACHTMENT E3: Confidential Record of Child Abuse Allegation Before completing, ensure the procedures outlined in Attachment C4 of the Insert Association Name Member Protection Policy – Part G (Complaint Handling Policy) have been followed and advice has been sought from the relevant government agency and/or police. Complainant’s Name: (if other than the child) Date Formal Complaint Received: / / Role/status in netball: Child’s name: Age: address: Person’s reason for suspecting abuse: (e.g. observation, injury, disclosure) Name of Respondent: Is the Respondent a financial member of Insert Association Name?  Yes  No  Unknown Role/status in netball:  Administrator (volunteer)  Parent  Athlete/player  Spectator  Coach  Support Personnel  Employee (paid)  Other  Official ……………………………….…….……. ……………………………………..…… Witnesses: (if more than 3 witnesses, attach details to this form) Name (1): Contact details: Name (2): Contact details: Name (3): Contact details: Interim action (if any) taken: (to ensure child’s safety and/or to support needs of person complained about) Police contacted: Who: When: Advice provided: