Club Response to an incident

Incident Report Number

Please type Incident Report Form Number here, as seen on the report without the “:”.

Club Name

Club Representative’s Name

Club Representative's Name

First

Surname

Mobile Number

Email Address

The alleged transgressor’s Name

The alleged transgressor's Name

First

Surname

His/her Mobile Number

His/her Email Address

Alleged transgressor’s Player Number in the Incident Report

Player 1

Player 2

Player 3

Player 4

The player number is indicated on the Incident Report Form.

The alleged transgressor’s charge level:

Section 1 – Level 1 or Level 2 charge

Section 2 – Level 3 or Level 4 charge

At least one option must be chosen. If the person in question has received a Section 1 and Section 2 charge, choose the Section 2 option.

The alleged transgressor’s response to the Level 1 charge.

He/she has challenged the Level 1 charge because:

Please provide any further information you require regarding this challenge (500 words max.).

Please ensure you are very clear in the reasons for challenging the report.

The alleged transgressor’s response to the charge.

He/she has challenged the charge because:

Alleged transgressor’s challenge document. (Mandatry)

Maximum file size: 2MB

Maximum of 2 files each being no larger than 2Mb.

Witness comments on the incident (appropriate).

Maximum file size: 2MB

A maximum of 4 documents not more than 2Mb in size may be uploaded.

Please add anything further you feel will assist in the assessment of the allegations.