Incident Report
Laporan Pelanggaran/breach of the code of conduct
Nama
*
Name
Bagaimana Anda ingin dikontak (How do you wish to be contacted)?
*
Email
Mobile phone
Email
*
Telepon
*
Mobile phone
Kategori insiden
*
Pihak yang akan Anda laporkan (who do you want to report?)
*
Staf/mitra (staff/partner)
Kepala Bagian/Program (Head of Department)
Pengurus (Chairperson/Secretary/Treasurer/Director)
Pengawas (Supervisory Board)
Pembina (Governing Board)
Penerima laporan yang Anda tuju (Your contact preference)
Pengurus (executive board)
Penerima laporan yang Anda tuju (Your contact preference)
Pengawas (supervisory board)
Penerima laporan yang Anda tuju (Your contact preference)
Pembina (governing board)
Kapan insiden terjadi?
*
-
Year
-
Month
Day
When did it happen?
Lokasi insiden
*
Where did it happen?
Nama individu yang terlibat
*
Name of individual(s) involved in the incident
Penjelasan kejadian
*
Description of the incident
Saran/keinginan Anda atas kejadian ini
What would you suggest to us on how we should handle the incident?
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