CORRUPTION REPORTING FORM

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Information

First name

Last name

Phone

Date

Whistleblower protection: « Whistleblowers are also protected against being sidelined, sanctions, demotion or transfer, discrimination or dismissal, unless the employer proves that such a measure is justified on grounds unrelated to the report ». See the French Sapin II Act, Article 6.

1. Context of the event

Location where the event occurred:

( Multiple choices possible )

a. Where exactly on the company premises:

b. Specify the location outside the company premises:

c. Specify which one(s) (email, telephone, etc.):

Date of the event

Approximate time

The data collected in this form, if it does not lead to an investigation, will be destroyed within 2 months, and otherwise 5 years after the end of the procedure.

2. People involved

How many participants (protagonists) were involved in the event (including yourself, if applicable)?

Number of protagonists, including you: 0

Are any legal entities (companies) or individuals from outside the company involved?

One or more individuals are involved
One or more legal entities are involved.

Identity of the persons targeted by the report (whose identity you know): who were the participants in the event?

Protagonist

Information

First name

Last name

Entity or company

Position(s) in the company

Entity or company

Last name

other Was on

How do you position yourself in relation to these individuals? Bystander (openly present), witness (not openly present), protagonist…

The data collected in this form, if it does not lead to an investigation, will be destroyed within 2 months, and otherwise 5 years after the end of the procedure.

3. Circumstances of the Event

Description of the circumstances of the event from your point of view:

Specify the precise nature of the gift, promise, presents or benefits? (gift, trip, bribe…)

Was there a trigger for the situation? (a remark, an email, behaviour…)

Was there an unusual element or event that could have warned of the occurrence of the reported event?

The data collected in this form, if it does not lead to an investigation, will be destroyed within 2 months, and otherwise 5 years after the end of the procedure.

4. Feelings / Psychological dimension

How did you feel at the time of the event?

At the time of the event: were you aware of the nature of the event (whether or not you were a protagonist)? In other words, did you know at the time of the event that it was corruption or a conflict of interest? If not, please specify at what point you realised it was corruption or a conflict of interest.

Yes
No (please specify)

At what point did you realise it was corruption or a conflict of interest?

Are you still psychologically affected by the event?

The data collected in this form, if it does not lead to an investigation, will be destroyed within 2 months, and otherwise 5 years after the end of the procedure.

5. Post-event behaviour

Did you speak with the protagonist(s) (or the other protagonists, if you were one yourself) about the event? If so, what was the outcome?

Yes (please specify)
No

What was the outcome?

Have you changed your behaviour after the event?

Are you more careful now?

The data collected in this form, if it does not lead to an investigation, will be destroyed within 2 months, and otherwise 5 years after the end of the procedure.

6. Would you like to remain anonymous during the investigation:

Would you like to remain anonymous during the investigation?

The data collected in this form, if it does not lead to an investigation, will be destroyed within 2 months, and otherwise 5 years after the end of the procedure.

Contact

Find us

1. Context of the event

2. People involved

Protagonist

Entity or company

3. Circumstances of the Event

4. Feelings / Psychological dimension

5. Post-event behaviour

6. Would you like to remain anonymous during the investigation:

Thank you for taking the time to answer these questions.

Corruption Report Form

1. Context of the event

2. People involved

Protagonist

Entity or company

3. Circumstances of the Event

4. Feelings / Psychological dimension

5. Post-event behaviour

6. Would you like to remain anonymous during the investigation:

Thank you for taking the time to answer these questions.