Create - Ethics Helpdesk

Case Management

Report No

1. What type of concern do you want to report? (Unethical Behaviour or Service Delivery Complaint)

2.Please give as much detail about the suspected irregularity:
2.1 What happened?

2.2 When did it happen?

2.3 Where did it happen?

2.4 Who are the persons/organisations involved?
(Name / surname / gender / nicknames / designations and employer / contact details / company or CC’s names and particulars / any personal particulars)

2.5 If a customer or supplier is involved, full details (name, reference number on CLIENT database if available etc.) if available?

2.6 If the suspect is an employee, who does he/she report to?

2. 7 What is each person’s role in the suspected irregularity?

2.8 Do you know how much money is involved? An estimate would suffice.

2.9 Do you know of any relations between the person(s) involved and a CLIENT employee? If so, elaborate.

3.It is not necessary for you to prove your suspicion.However, if you can provide us with any proof, it will assist us a great deal in investigating the matter successfully. Do you have any proof / evidence or documentation at your disposal ? (Yes or No)

4.Is there a possibility that any other person may have knowledge of the suspected irregularity, or evidence at his / her disposal ? (If so, what is his / her name, designation, employer, contact details, work address etc.)

5.Have you reported this matter to any other authority? E.g.SAPS, another CLIENT employee etc.?

6.Do you know of any reason why any person may not assist us in following up this report?

7.Would you like us to provide you with feedback on the matter ? (Yes or No)

8.Do you wish to remain anonymous ?

You have the right to remain completely anonymous. However, it may assist the investigator if you make yourself available for an interview, to obtain more information.
By giving your name and contact details to us, it will still remain confidential and may only be disclosed if an investigation is approved (and not CLIENT) if you wish.However, it is still your choice.

Anonymous Non-Anonymous

If you are willing to identify yourselves, you may select the mode of communication with the investigators. What particulars are you willing to disclose?

Full Name

Client - Employer Position:

Non-Client Employee:

Personal Email:

Work Email:

Contact Number :

What are the most convenient times to contact you?

Is there anything you would like to add, or any comments we must record?

Attachment (Optional)

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