This legal template includes 13 fields. Confidential submission form for whistleblower complaints regarding corporate misconduct. Free to customize and use on ZenBuild.
Name (optional - can be anonymous) (text, optional)
Secure Contact Email (optional) (email, optional)
Type of Misconduct (dropdown selection, required) — options: Financial Fraud, Securities Violation, Environmental Violation, Safety Violation, Bribery/Corruption, Tax Evasion, Data Privacy Breach, Discrimination, Retaliation, Regulatory Non-Compliance
Department or Division Involved (text, optional)
Date(s) of Misconduct (text, required)
Duration (dropdown selection, required) — options: Single Incident, Days, Weeks, Months, Years, Ongoing
Detailed Description of Misconduct (long text, required)
Individuals Involved (names and titles) (long text, optional)
Do You Have Documentary Evidence (multiple choice, required) — options: Yes, No, Possibly
Supporting Documents (file upload, optional)
Previously Reported Internally (multiple choice, required) — options: Yes, No
Previous Report Reference Number (if any) (text, optional)
Fear of Retaliation (multiple choice, required) — options: Yes, No
