Whistleblowing Report Form
Template
Reports under the Whistleblowing policy can be made orally or in writing and they may be made anonymously or include the reporter's identity.
To make a report in writing (either anonymously or including your identity) please complete this form, in as much detail as possible, and send to insert name and contact details of person/department to send reports to.
Whistleblowing report
Type of conduct (i.e., what was said or done?) | Insert description |
Individual(s), department(s) and/or team(s) involved | Insert details |
Frequency of occurrence | Insert details |
Date(s) of occurrence | Insert details |
Place(s) of occurrence | Insert details |
Do you have direct knowledge of the matter being reported? | Yes/No If ‘Yes', insert details If no, how did you become aware of it? |
Do you know if anyone else is aware of the matter being reported? | Yes/No If yes, please identify them and detail how they became aware |
Does the matter being reported affect you or your work? | Yes/No If yes, please describe how |
Additional information/further comments | Insert details |
Person making report (optional)
Name |