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Instructions

Use this form to confidentially report EOAC policy violations. Your name, site, and other identifying information is NOT required, however, if the information is not provided, we cannot contact you directly with any outcomes, or ask you any further questions. Any information provided will be investigated with all regards to confidentiality. Only those with a need-to-know will be involved in the investigation. 

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* 1. Your Name (Not Required - can be left blank)

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* 2. Your Site (Not Required - can be left blank)

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* 3. Date/ Time the policy violation occurred

Date
Time

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* 4. Please explain how the situation occurred. Please include as much information as possible, including where the violation occurred, what happened, and who the violation was reported to (if reported). If you didn't list a date/time above, or can't remember the exact date/time, please provide what information you remember regarding the date/time of the violation. 

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* 5. Please list any other information you feel will help explain the situation listed above. 

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