Whistleblower Form

Company

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Nature of Concern

Type of concern(Required)

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Ethical Violations

Safety Issues

Financial Misconduct

Harassment or Discrimination

Legal Violations

Other (Please Specify)

Other(Required)

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Details of the Incident

Date of incident(Required)

Time of incident(Required)

Location of incident(Required)

Description of incident(Required)

Individuals involved(Required)

List individual(s) involved, as well as their roles & position if known.

Your Contact Information (Optional)

While this is an anonymous form, providing contact information can be helpful if further information is needed or you want to be updated on progress. This section is entirely optional.

Name

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Submission

Acknowledgement(Required)

I understand that this report is being made in good faith and is based on information I believe to be accurate to the best of my knowledge.

Whistleblower Form