South Adelaide Basketball Club - Feedback/Complaint Form

South Adelaide Basketball Club – Member Protection & Incident Report

This form allows you to raise a concern, complaint, or provide feedback about behaviour, safety, or wellbeing within our club community.
It can be used by players, parents, coaches, officials, volunteers, or members of the public.

Your report is confidential and will be reviewed by our independent Member Protection Officer, not by club management.
They will assess the information you provide and determine the most appropriate next steps in line with our Member Protection and Child Safety policies.

You may choose to remain anonymous. However, providing contact details can help us follow up and ensure the matter is handled properly.

If someone is in immediate danger, please contact 000 or the Child Abuse Report Line (13 14 78) before completing this form.

Section 1: About This Report

What type of report are you making?*

Feedback

Concern

Complaint

Child safety concern

Other (please specify)

Is this report urgent or do you believe someone is currently at risk of harm?*

(if Yes): Display message with emergency contacts (Police 000, Child Abuse Report Line 13 14 78).

Yes

Unsure

Section 2: Reporter Information

Do you wish to remain anonymous?*

Choosing to remain anonymous may limit our ability to investigate or provide updates, but your report will still be reviewed

Yes

Would you be willing to be contacted through a confidential intermediary (such as an external Member Protection Officer*

Yes

Name (optional if anonymity selected)

Preferred contact method

Phone

Other

Contact details

Your relationship to the incident:*

I am the person directly affected

I am a parent/guardian of the person affected

I witnessed the incident

I was told about the incident by someone else

Other (please specify)

Section 3: Incident Details

Date of occurrence (or first date if ongoing):*

Is this an ongoing issue or one-time incident?*

One-time

Ongoing

Part of a pattern of behaviour

Location of incident:*

At club venue during game/training

At club venue during another activity

At away game/event

Online/social media

Other location (please specify)

Who was involved in the incident?*

Player

Coach

Team manager

Club administrator/staff member

Volunteer

Spectator

Unknown person

Multiple people (please specify)

Is the person affected under 18 years of age?*

Yes

Prefer not to say

Unknown

Please describe what happened (in your own words):*

“You do not need to include every detail — focus on what happened, where, and who was involved. Avoid describing traumatic detail.”

Were there any witnesses?*

Yes (please provide names if known and willing to share)

Yes

but I don’t know who they were

Unsure

Have you spoken to anyone else about this incident?*

Yes - informally to club member/staff

Yes

to a Member Protection Officer

Yes

to external support service

Other (please specify)

Has this incident been reported elsewhere?*

No - this is the first report

Yes - to police

Yes - to another sporting organisation

Yes - to Department for Child Protection (or equivalent) Yes - to school

Other (please specify)

Section 4: Impact and Safety

How has this incident affected you or others involved?

Is there anything we should know to ensure this process is culturally safe or accessible for you?

e.g., need for interpreter, cultural considerations, accessibility requirements.

Section 5: Desired Outcome

What outcome are you seeking?*

Investigation of the incident

Apology

Education/training for person involved

Policy change or review

Disciplinary action

Support services or counselling

No action — I just wanted to report it

Other (please describe)

Section 6: Consent and Acknowledgement

Consent and understanding: I understand that: The information I provide will be handled confidentially and only shared with those who need to know. South Adelaide Basketball Club may have legal obligations to report certain matters to authorities. I may be contacted for additional information if I have not chosen to remain anonymous. False or malicious complaints may result in action being taken. I can access support services at any time.”*

Yes

Section 7: Support and Resources

Kids Helpline — 1800 55 1800
Lifeline — 13 11 14
1800RESPECT — 1800 737 732
Child Abuse Report Line (SA) — 13 14 78
South Adelaide Basketball Club Member Protection Officer — memberprotection@southadelaidebasketball.com.au