Person reporting is Select Agency employee Employee Former employee From outside the organization

Report type Select Conflict of interest Discrimination Food safety/quality/legality and authenticity Harassment Inappropriate behavior Other

Location

Whom it concerns Select Another person / People Myself Outside the organization

Date of Event

Has the situation happened before? Select Yes No

Were there any witnesses to the event? Select Yes No

Was the supervisor informed? Select Yes No

Has the situation been reported to anyone before? If so, to whom and when

Description of the situation

Do you have any supporting documentation/evidence? Select Yes No

Attachment

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