Benefits Fraud Report Form
Submit details of suspected misuse of employee benefits. Your report will be handled confidentially. Please provide as much information as possible.
Would you like to remain anonymous?
*
Yes
No, I am willing to provide my contact details
Your Full Name (optional)
First Name
Last Name
Your Email Address (optional)
example@example.com
Your Relationship to the Person or Department Involved
*
Please Select
Employee - Same Department
Employee - Different Department
Manager/Supervisor
HR/Benefits Staff
Contractor
Other
Type of Benefit Suspected to be Misused
*
Please Select
Health Insurance
Retirement/Pension
Paid Leave (Vacation, Sick, Parental)
Disability Benefits
Flexible Spending Account
Other
Who or what is suspected of benefits misuse?
*
When did the suspected misuse occur?
*
Where did the suspected misuse occur?
*
Describe your concern in detail
*
Upload any evidence or supporting documents (optional)
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