Fraud Incident Report
To report an incident, please provide the following information.
Today's date and time:
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AM/PM Option
Date and time when incident actually occurred:
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Minutes
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PM
AM/PM Option
Your name: (Leave blank if reporting anonymously)
First Name
Last Name
You are a:
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Current Employee
Former Employee
Other
Fill in all that apply:
May we contact you for follow up or additional information?
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Yes
No
If yes, how would you prefer to be contacted?
Incident Details
Names of parties involved in the incident:
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Describe incident/activity that may violated law, state policy, or ARDOT policies and procedures:
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Did you directly witness the incident/activity?
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Yes
No
Did others witness the activity or are aware of the incident?
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Yes
No
Names of additional witnesses and contact information, if available:
Vehicle number: (if known)
Description of vehicle: (if applicable)
Is there evidence available?
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Yes
No
If yes, describe evidence available: (i.e., photos, etc.)
Further general comments and/or additional information:
Submit Report
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