Whistle blowing form

Confidential Whistleblower Disclosure Form

Section A: Information About the Reporter (Optional)

I wish to remain anonymous

Full names *

Position/Relationship to AGDF

Phone Number

Email address *

Section B: Details of the Allegation

Please describe the incident in detail:

When did it happen? (Date, time, frequency)

Where did it happen? (Location, department, project name)

How was it carried out? (Method used)

Nature of the Concern (Check all that apply):

Fraud / Financial Misconduct

Corruption / Bribery

Theft / Embezzlement

Misuse of Assets

Conflict of Interest

Ethical Violation

Gross Mismanagement

Safety Violation

Other (Specify below)

Section C: Persons Involved

Person(s) alleged to be involved:

Witness(es) or other persons with information: