Name of MPIO: Date: / / Complainant’s Name:   Over 18 Under 18 Role/status in netball:   Administrator (volunteer) Parent   Athlete/player Spectator   Coach/Assistant Coach Support Personnel   Employee (paid) Other  Official ……………………………….…….……. ……………………………………..…… Location/event of alleged issue: Facts as stated by complainant: Nature of complaint:   Harassment OR Discrimination (category/basis/grounds)   Sexual/Sexist Selection Dispute Can tick more than one   Sexuality Personality Clash box   Race Bullying   Religion Verbal Abuse   Pregnancy Physical Abuse   Disability Victimisation  Child Abuse 
Name of MPIO: Date: / / Complainant’s Name:  Over 18  Under 18 Role/status in netball:  Administrator (volunteer)  Parent  Athlete/player  Spectator  Coach/Assistant Coach  Support Personnel  Employee (paid)  Other  Official ……………………………….…….……. ……………………………………..…… Location/event of alleged issue: Facts as stated by complainant: Nature of complaint: (category/basis/grounds) Can tick more than one box  Harassment OR  Discrimination  Sexual/Sexist  Selection Dispute  Sexuality  Personality Clash  Race  Bullying  Religion  Verbal Abuse  Pregnancy  Physical Abuse  Disability  Victimisation  Child Abuse 
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