Grievance or Whistleblower form

Your feedback is important, the protection of yourself, company and the customers are important.

GRIEVANCE PURPOSE : This form is to be used by employees who have a grievance that they have not been able to resolve through informal discussion.

WHISTLEBLOWER PURPOSE: This form can be used for Employees Who wish to Report Corruption, theft, Discrimination, Harassment, and Fraud towards another team member or the company.

Providing the information below and confirming your contact details will assist staff at BOORN (the Company) to address your matter in a timely manner.

Failure to provide the requested information may result in a delay in processing your submission.

Your information is treated confidential send to senior management to process, depending on the matter you may re quired to provided further information through an investigation or formal process.

First Name *

Last Name *

Phone Number *

Email Address

Purpose of submission *

Grievance (Abuse, harassment, or discrimination) Whistleblower ( Staff theft, harassment, Fraud, Corruption) BothUnsure

Have you attempted to resolve the incident? *

YesNoUnsure how

Details on what actions you have completed informally before completing this form in any

Other; Comment below

Date or estimated date of reportable concern *

People involved in the incident:

Full Details of the incident, including time, place, witnesses

What actions do you want to see the company undergo? *

Any photos of evidence

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I can confirm all the information i have provided is true and correct. I understand I may be contacted further for additional information.

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