Fill a general complaint

CONFIDENTIAL

This form is used to bring to the attention of the Federation an incident in the practice of scuba diving.

All information marked * is required to submit the form.

    Date of the event (jj-mm-aaaa)
    Time of the event (hh:mm)
    * Location of the event (address if applicable)

    Related to :

    Who is affected by the incident?

    Did the incident have any consequences?
    Specify the consequences:

    Did the incident occur during a course?
    Specify the detail of the course

    * Describe the event
    Please report the details of the event or situation you witnessed including the factors you believe contributed to the incident.

    Add an attachment - to add more than one item, please attach them in a compressed file

    * Witness (person filling this form):
    Phone number (999-999-9999):
    * Your email:

    I authorize Québec Subaquatique to collect, hold, use and disclose all personal information about me that it deems necessary to process my complaint for the duration of the complaint process. If my complaint concerns or involves an agent of the Federation, I expressly understand and agree that the information contained in this report may be used and disclosed in its entirety to the agent in question as part of the disciplinary process in effect. The information contained in this report will be treated as confidential. Therefore, subject to the foregoing paragraphs, the facts and information contained in my report may only be disclosed to the public by the Federation for the purpose of informing the public about safety in sport and once the information identifying me and the persons involved, i.e. names including locations, has been removed.