Report | USA Hockey Safe Sport Report

Please provide information on the person you are reporting. If you do not know the person's name, please provide other identifying information. Name (First, Last) :*

Age or Approximate Age of the person you are reporting:*

Gender:*

Male

Female

Clear Current Selection

Address 1:

Address 2:

City:*

State/Province:*

Position(s) this individual holds or held:*

Head Coach

Asisstant Coach

Employee for local program

Volunteer/Team Manager

Official/Referee

Other

Not Sure

Other Position:*

Hockey program where individual works and/or volunteers or worked/volunteered previously:*

Please provide as much specific information as you are able:*

Type of Offense (i.e. what happened?)

Where did the incident take place?:*

City, State, and any other available information

Please describe what happened:*

Including Who, What, When Where

This section is for information about the victim or victims. If you are the victim and wish to remain anonymous, you may do so. In that case, please enter only your age, city, state and the hockey program with which you are affiliated.

Victim Name:

First and Last Name

Age:*

City:*

State:*

Program Affiliation:*

Phone Number:

Email:*

Note, if this person is under 18, please provide contact information for his/her parent or guardian

Gender:

Male

Female

Clear Current Selection

You may remain anonymous if you wish. However, providing your information is vastly helpful to a swift and effective investigation. A person reporting alleged misconduct should not fear any retribution and/or consequence when filing a report he or she believes to be true.

Name of Reporter:

First and Last Name

Phone Number:

Email Address:

Program Affiliation (if any):

Relationship to Victim (if any):

Self

Parent/Guardian

Other Family Member

Friend or Acquaintence

Program Member

Coach/Volunteer

Other

Prefer not to say

If you have any other information that you feel would be helpful to an investigation of the alleged offense you have reported, please enter it here:

First Name:

Last Name:

email:*