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Run: Whistleblower Complaint Intake Form

Use this whistleblower complaint intake form to capture misconduct reports with anonymous submission, confidentiality concerns, witness details, and supporti...

Fill this out, get a PDF emailed to you. No sign-up required. Want to run it with your team and track results? Sign up free →

Reporting Options and Consent

How would you like to submit this report? (required)

Consent and disclosure acknowledgement (required)

I understand this form may collect limited PII if I choose to provide it, and that the information will be used only for compliance review, investigation, and audit trail purposes.

Yes No N/A

Do you have confidentiality or retaliation concerns? (required)

Please describe your confidentiality or retaliation concerns

Share only what is necessary. Do not include sensitive personal data unless it is directly relevant.

Reporter Information

Your name

Your relationship to the organization

Email address

Provide an email only if you want to be contacted for follow-up.

Phone number

Optional contact number for follow-up.

Incident Details

Date of incident or first observed issue

If the issue occurred over time, provide the earliest known date.

Location or department involved

Type of concern (required)

Describe what happened (required)

Include who was involved, what occurred, when it happened, and why you believe it is misconduct.

Is this an ongoing issue? (required)

People and Witnesses

Person or team involved

If you do not know a name, provide a role, title, or team.

Were there any witnesses? (required)

Witness details

Add only the witness information you know and are authorized to share.

Supporting Evidence and Follow-Up

What supporting evidence do you have?

Upload supporting evidence

Upload only files that are relevant to the report and permitted by policy.

How should we follow up? (required)

Anything else we should know?

Get your results

Enter your email — we'll send you a PDF of your filled-out template. We won't sign you up to anything; you can opt in to the trial from the email if you want.

Email (required)

Your name (optional)

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