Page 275 - New Silat Rules 2020

Annex 1 – Safe Sport Incident Report Form

PERSILAT believes each person related to the organization should be safe from any type of
harm and is committed to safeguard all those that are vulnerable. If you happen to witness
or are involved in any harm done to anyone related to the organization, please follow the
steps below:

Procedures:

1. When you see any harm inflicted on any person related to PERSILAT, fill in the boxes
below and email it to cb_persilat@yahoo.co.id.
2. The suspected person/s who were involved will be temporarily suspended from duty
while the investigation is on-going.
3. The safe sport officer and disciplinary committee will conduct an investigation that will
last between 1 to 2 weeks (or more depending on the amount of evidence).
4. Once concluded, the officer and disciplinary committee will inform the persons involved
on the decision made.

Name of Person reporting suspected issue

Mobile No. & Email Address

Date of Incident

Location/Venue of Incident

Name of suspected person

Name of others involved

Team Name

Incident report

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