Whistle Blower Policy Reporting

Whistle Blower Policy Reporting
PURPOSE

This form is intended for individuals to report any unethical, illegal, or unsafe activities occurring at Henry's Home. Please provide as much detail as possible to assist in addressing your concerns. Your report will remain confidential, and you may choose to remain anonymous.
CONTACT INFORMATION (Optional)

Providing your contact information allows us to follow up with you regarding your report. If you prefer to remain anonymous, leave this section blank.
Name

First NameLast Name
Cell phone number
Please enter a valid phone number.
Email
example@example.com
DETAILS OF INCIDENT OR CONCERN
Type of Incident or Concern (Check all that apply):*

Fraud or corruptionHarassment or discriminationMisuse of funds, resources, or propertyUnsafe practices or working conditionsViolation of sanctuary policies or proceduresOther
Other
Date of Incident or Concern*

MonthDayYear
Time of Incident or Concern*

Hour Minutes

AM/PM Option
Location of Incident or Concern:*
Names of Individuals Involved:*
Witnesses (if any)
6. Describe the Incident or Concern in Detail*
Do You Have Any Evidence or Documentation?*

YesNo
Please describe*
Attached document as required

Cancelof
ACTION TAKEN
8. Have You Taken Any Steps to address this concern before?*

YesNo
Please describe*
Thank you for helping us maintain a transparent, ethical, and safe environment at Henry’s Home. We value your integrity and commitment to our sanctuary.
Role (Optional)
Other
Consent

By checking this box, I agree to use an electronic signature for this agreement, and I confirm it is an electronic representation of my signature for purposes of this agreement.
Signature (Optional)
By signing, I acknowledge that I have read and understand and voluntarily agree to this waiver and release. Just type your initials.
Date of signature

MonthDayYear
By providing your email address, you are opting in to receive communications from Henry’s Home. You may opt out at any time.
Should be Empty:

Whistle Blower Policy Reporting

CONTACT INFORMATION (Optional)

DETAILS OF INCIDENT OR CONCERN

ACTION TAKEN

Thank you for helping us maintain a transparent, ethical, and safe environment at Henry’s Home. We value your integrity and commitment to our sanctuary.