Inclusion Policy Complaint Form

COMPLAINT FORM

SAWHA INCLUSION POLICY

If you have experienced an incident in violation of the SAWHA Inclusion Policy, we encourage you to fill out the form below.

Name of the Complainant *

First

Last

SAWHA Team (or Board position or Referee #) *

Phone Number: *

Today's Date *

Email *

Date of Incident:

(if more than one event, please report each event on a separate form.)

Where did the event occur?

Be specific: on ice, dressing room, parking lot, social media?

Please explain the events that occured

Include as many details as possible

Did you or anyone else intervene or otherwise react to the situation? If so please describe in detail?

Describe the harm that was suffered by you or anyone else as a result of the event.

Were there any witnesses to this specific event?

If yes, please provide their names and contact information

Is there any physical evidence that supports your complaint? If so, please describe or attach a copy of evidence, i.e.: video or pictures

What is your desired outcome of the investigation?

The information provided in this complaint is true and correct to the best of my knowledge. I am willing to cooperate fully in the investigation of my complaint and provide whatever evidence SAWHA deems relevant. *

YES, I agree