QAS Athlete Safeguarding Report Form

This form is to be used by QAS supported athletes, coaches and QAS staff members for reporting a concern regarding the safety and wellbeing of a QAS supported athlete.

If the concern DOES NOT involve the safety and wellbeing of QAS supported athlete, please contact the QAS People and Culture team at qashr@dtis.qld.gov.au.

Phone Triple Zero (000) if it is an emergency or if you believe a QAS supported athlete is in immediate danger or a life-threatening situation. Then proceed to record and submit your report.

Full name *

Contact phone number *

Email *

Your QAS role *

Date the incident occurred *

Day Month Year

Athlete's name *

Is the athlete under the age of 18? *

Yes
No
Unsure

What is the athlete's role in this report? *

Alleged victim
Alleged offender
Witness

QAS sport program *

Reason for concern *

Observation
Disclosure
Other

Name of person involved in your concern *

What is this person's role in the incident? *

Alleged victim
Alleged offender
Witness

Is this person under the age of 18? *

Yes
No
Unsure

Name and details of other persons involved or witness to the alleged concern *

Brief description of the concern *

Have you raised this concern? *

I agree with the privacy statement * The Department of Tourism, Innovation and Sport (Queensland Academy of Sport) is collecting your personal information such as your name, phone number, email, signature, and other personal information in this form for the purposes of assessing, investigating, managing, and corresponding with you in relation to the matters raised on this form. The personal information will be managed in accordance with the Information Privacy Act 2009 and will not be otherwise used or disclosed unless authorised or required by law. Information regarding the department’s privacy policy can be found at https://www.dtis.qld.gov.au/site-information/privacy.

Agree

QAS Athlete Safeguarding Report Form

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