Complaint/Whistleblowing Form

Complaint/Whistleblowing Form

Your safety and confidentiality are our priority. This form allows you to report concerns about unethical, illegal, or inappropriate conduct within our organization.
- Note: You may choose to remain anonymous. However, providing contact details may help us follow up for further information.
- Name
  
  First NameLast Name
- Phone Number
  Please enter a valid phone number.Format: (000) 000000000.
- Email
  example@example.com
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Prefered method of contact
  
  EmailPhoneIn personOther

- Please enter the date(s) the misconduct occurred. If you remember the time(s), you can enter.
- Please provide details of person(s) involved (if known):
- Description of the misconduct (Please be detailed):*
- Relationship to the complainant*
  
  SubordinateSupervisorCo-workerOther
- Does misconduct continue?*
  
  YesNo

- Please describe any evidence you have (documents, emails, photos, etc.)
- Please provide any related files (Photos, documents, voice records, etc.)
  
  Cancelof
- Have you ever complained or provided information verbally and/or in writing about sexual harassment?*
  
  YesNo
- Please give more detail

- If there are other involved parties and witnesses), Please write here.
- Do you have a legal counselor and would like us to work with them?
  
  YesNo
- Please give your legal counselor's contact information
- What action would you like to see taken?*
- We assure you that all reports will be treated with the utmost confidentiality and without any retaliation against the reporter.
- Please verify that you are human*
- Should be Empty: