Economic Crime And Fraud Survey Form
Survey form for reporting or describing economic crime and fraud incidents, observations, and impact. Please provide non-sensitive details only.
Respondent Profile
Respondent role or relation to the incident
*
Organization or sector type
*
Banking/Finance
Retail
Government
Healthcare
Education
Manufacturing
Technology
Nonprofit
Other
Incident Overview
Incident title or summary
*
Incident type
*
Fraud
Scam
Embezzlement
Money Laundering
Bribery/Corruption
Cyber-enabled Fraud
False Invoicing
Identity Theft
Other
When was the incident first noticed?
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Details and Impact
What happened?
*
Estimated severity or impact
*
Low
1
2
3
4
Severe
5
1 is Low, 5 is Severe
Impact assessment
*
Rows
None
Low
Moderate
High
Severe
Financial loss
1
2
3
4
5
Operational disruption
6
7
8
9
10
Customer impact
11
12
13
14
15
Reputational impact
16
17
18
19
20
Reporting and Follow-up
Has the matter already been reported?
Not yet
Internal compliance/risk team
Law enforcement
Regulator
Auditor
Other
Follow-up email address
example@example.com
Submit
Should be Empty: