CORRUPTION REPORTING FORM

Information

First name

Name

E-mail

Phone

Date

Protection of whistle-blowers: “Whistle-blowers are also protected against dismissal, sanctions, reclassification or transfer, discrimination or dismissal, unless the employer demonstrates that this measure is justified by factors other than the whistle-blowing”. Cf Loi Sapin II Article 6.

1. Background to the event

or time the

Location of event:

( Several possible choices )

Date of event

Approximate time

Data collected on this form and not investigated will be destroyed within 2 months and otherwise 5 years after the end of the procedure.

2. People involved

How many people were involved in the event (including you, if applicable)?

Nombre de protagonistes, vous compris : 0

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

One or more natural persons are involved
One or more legal entities are involved.

How do you position yourself in relation to these actors? Spectator (openly present), witness (not openly present), protagonist...

Data collected on this form and not investigated 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, present or benefit (gift, trip, bribe...)

Was there anything that triggered the situation (words, e-mail, behavior, etc.)?

Was there any unusual element or event that could have alerted us to the occurrence of the event that was the subject of the alert?

Data collected on this form and not investigated will be destroyed within 2 months and otherwise 5 years after the end of the procedure.

4. Feeling / 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 involved), i.e. did you know at the time of the event that corruption or a conflict of interest was involved? If not, when did you realize it was a case of corruption or conflict of interest?

Yes
No (please specify)

Are you still psychologically affected by the event?

Data collected on this form and not investigated will be destroyed within 2 months and otherwise 5 years after the end of the procedure.

5. Post-event behavior

Did you talk to the protagonist(s) (or other protagonists if you were one yourself) about the event? If so, what came out of it?

Yes (please specify)
No

Did you change your behavior after the event?

Are you paying more attention?

Data collected on this form and not investigated will be destroyed within 2 months and otherwise 5 years after the end of the procedure.

6. Do you wish to remain anonymous during the survey:

Souhaitez-vous rester anonyme au cours de l’enquête ?

Data collected on this form and not investigated will be destroyed within 2 months and otherwise 5 years after the end of the procedure.

Thank you for taking the time to answer these questions.

Information

First name

Name

E-mail

Phone

Date

1. Background to the event

Location of event:

( Several possible choices )

Date of event

Approximate time

Data collected on this form and not investigated will be destroyed within 2 months and otherwise 5 years after the end of the procedure.

2. People involved

How many people were involved in the event (including you, if applicable)?

Nombre de protagonistes, vous compris : 0

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

One or more natural persons are involved
One or more legal entities are involved.

How do you position yourself in relation to these actors? Spectator (openly present), witness (not openly present), protagonist...

Data collected on this form and not investigated 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, present or benefit (gift, trip, bribe...)

Was there anything that triggered the situation (words, e-mail, behavior, etc.)?

or company Date

Was there any unusual element or event that could have alerted us to the occurrence of the event that was the subject of the alert?

Data collected on this form and not investigated will be destroyed within 2 months and otherwise 5 years after the end of the procedure.

4. Feeling / Psychological dimension

How did you feel at the time of the event?

Yes
No (please specify)

Are you still psychologically affected by the event?

Data collected on this form and not investigated will be destroyed within 2 months and otherwise 5 years after the end of the procedure.

5. Post-event behavior

Did you talk to the protagonist(s) (or other protagonists if you were one yourself) about the event? If so, what came out of it?

Yes (please specify)
No

Did you change your behavior after the event?

Are you paying more attention?

Data collected on this form and not investigated will be destroyed within 2 months and otherwise 5 years after the end of the procedure.

6. Do you wish to remain anonymous during the survey:

Souhaitez-vous rester anonyme au cours de l’enquête ?

Data collected on this form and not investigated will be destroyed within 2 months and otherwise 5 years after the end of the procedure.

Contact

Find us

1. Background to the event

2. People involved

Protagonist

Entity or company

3. Circumstances of the Event

4. Feeling / Psychological dimension

5. Post-event behavior

6. Do you wish to remain anonymous during the survey:

Thank you for taking the time to answer these questions.

1. Background to the event

2. People involved

Protagonist

Entity or company

3. Circumstances of the Event

4. Feeling / Psychological dimension

5. Post-event behavior

6. Do you wish to remain anonymous during the survey:

Thank you for taking the time to answer these questions.

Formulaire de Signalement de Corruption

1. Background to the event

2. People involved

Protagonist

Entity or company

3. Circumstances of the Event

4. Feeling / Psychological dimension

5. Post-event behavior

6. Do you wish to remain anonymous during the survey:

Thank you for taking the time to answer these questions.

Corruption Report Form

1. Background to the event

2. People involved

Protagonist

Entity or company

3. Circumstances of the Event

4. Feeling / Psychological dimension

5. Post-event behavior

6. Do you wish to remain anonymous during the survey:

Thank you for taking the time to answer these questions.