World Archery: Online Safeguarding Report Form

Please complete this form if you have a concern about your own or someone else’s well-being and include your name and phone number or email address so we can contact you to follow up this concern. The World Archery Safeguarding Officer will contact you following receipt of the report. To keep children and adults safe, information may need to be shared appropriately with other entities.* However, confidentiality will be maintained where appropriate and to ensure that only those who need the information are made aware of it.
If you have any queries or concerns about the information you are providing, you can contact the World Archery Safeguarding Officer at safeguarding@archery.sport.

If a child or vulnerable adult is in immediate danger or there is concern that a crime has been committed, please contact the police immediately.

First Name: * Person reporting the safeguarding concern.

Surname: * Person reporting the safeguarding concern.

Phone: Person reporting the safeguarding concern.

Email: Person reporting the safeguarding concern.

Role:

Persons Involved

Victim

Person who concerns are for

Adult (18+) or Child?

Adult (18+)

Child

Is the victim aware of the report?

Yes

Name of Alleged Victim:

First Name

Surname

Date of Birth:

Phone: Contact Details for Victim’s Parent/Carer/Appropriate Adult/Personal Assistant

Email: Contact Details for Victim’s Parent/Carer/Appropriate Adult/Personal Assistant

Role:

Please Specify:

Subject of Concern

Person who is accused of alleged wrongdoing

Name of Subject of Concern:

First Name

Surname

Date of Birth:

Role:

Sex:

Address:

Post Code:

Telephone Number:

Email Address:

Actions already taken: Are you aware of any local authority /police involvement in this case? If yes, please provide details

Have any of the individual's family or carers been notified of this concern?

Yes

If yes please provide details of what was said/action agreed.

Has the national archery federation been contacted about this case?

Yes

Details of Concern

Date Occurred:

Time Occurred:

Location of the incident and nationality of people involved:

Incident Type:

Category of Concern:

Inside or Outside of Sport:

Describe your concerns: Include all the relevant information, such as detailed description of your concerns and reasons for these. Please describe any injuries or actions causing concern and whether you are recording these as fact, opinion or hearsay.

Are you reporting your own concerns or responding to concerns raised by someone else?

If responding to concerns raised by someone else please their contact information. Name, Position within the sport or relationshop to the individual concerned, telephone number, email address

Witnesses or Supporting Accounts Please provide details of any one who has shared your concerns or witnessed any incident: Name, Position within the sport or relationship to the individual concerned, DOB, Address, Postcode, Telephone Number, Email Address

Conflicts of Interest: Do you have any relationship with anyone involved in this case which could cause a conflict of interest in any investigations? If yes, please describe your relationship

Signature:

*Information about who World Archery shares safeguarding information with can be found in our Safeguarding Policy and Procedures which is available to view on our website: https://www.worldarchery.sport