JUNIOR PANEL / INCIDENT REPORT

Juniors Incident And Accident Report All matters, accidents and injuries raised are required to be formally documented for transparent and appropriate actions by Club Management.
For matters relating to Juniors (U10-U18), this report will be forwarded to the Junior Panel who will review, manage and respond accordingly. Depending on the nature of the matter, the matter will be escalated to the JDO, Management Committee and/or Basketball SA. The timing for outcomes or response will vary accordingly.

Your Name*

First Last

Keep your submission 'anonymous' in Panel and Management discussions? Permission will be sought to disclose if and when essential.

Yes
No

Your Email*

Your Phone Number*

Your Child(s) Player Name*

Your Child(s)Team*

(E.g. Girls U12 Div2)

Type of Notification*

Incident/Event
Accident/Injury
Issue/Concern

Advise the level of Sensitivity*

Not Sensitive - It is a general observation or just involves my player only
Sensitive - It involves other players and/or parent
Very Sensitive - It is a serious matter and/or private matter

Does the matter involve 'child safety' and need to be escalated to the Child Safety Officer?*

Yes
No
Not sure

When and Where did the matter or accident/injury occur?*

Describe the matter or accident/injury in detail?*

Have you discussed the matter with?

Team Manager
Coach
Other Parents
Court Supervisor (game)
Junior Panel/Committee Member
JDO
Other
No-one

What steps have you taken to resolve or action the matter?*

If an accident or injury, what response or first aid was applied and by who?

What actions or outcomes would you like to see from lodging this report?*