Whistleblowing Risk Assessment Form
Please provide details to help us assess the risk level and nature of this whistleblowing report.
Briefly summarize the report or concern
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Select the category that best describes the report
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Please Select
Fraud or financial misconduct
Safety or health violation
Harassment or discrimination
Data privacy or security issue
Policy or regulatory breach
Other
How would you rate the seriousness or potential impact of this issue?
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1
2
3
4
5
How urgent is this issue?
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Immediate action needed
High urgency
Moderate urgency
Low urgency
Is supporting evidence available?
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Yes, evidence is available
No, but evidence may be obtainable
No evidence available
Who is primarily affected by this issue?
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Please Select
Employees
Customers or clients
Suppliers or partners
Public or community
Other
Do you wish to remain anonymous?
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Yes, I prefer to remain anonymous
No, I am willing to be contacted for follow-up
How should this report be handled?
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Handled internally only
Escalate to external authorities
Both internal and external handling
Please indicate any previous actions taken regarding this issue
List any follow-up details or contact information (if willing to be contacted)
Submit Assessment
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