Incident Report Form

Please complete the form below if you would like to report a breach of the Vytis Knights Codes of Conduct.

This form will be reviewed by the Vytis Knights Committee and a member of the committee will be in contact as soon as possible.

Your Name

First Name

Last Name

Phone

Date of incident

YYYY

Time of incident

Location of incident

Please detail the involved parties

Name(s) of individual(s) involved in the breach Role of the individual(s) involved (e.g., player, coach, parent, spectator)

Description of the incident

Detailed account of what happened (who, what, where, when, how) Nature of the breach (e.g., verbal abuse, physical altercation, unsportsmanlike conduct, discrimination, failure to follow safety rules) Any prior incidents involving the same person(s)? (if known)

Were there any photos, videos, or other evidence?

If yes, we may ask you to supply these.

Yes

Would you like to remain anonymous in any follow-up actions?

Yes