Reporting Irregularities Form

Reporting Violations in the Workplace – Form

For internal reporting of breaches of regulations in the workplace in accordance with the Whistleblower Protection Act (ZZPri).

Scope of issue * (You may select only one category)

Name & Surname *

Address *

Email address *

Phone number *

I am submitting this report anonymously (in this case, do not fill in the reporter’s details).

The report may be submitted anonymously, without disclosing personal data; however, this may make it more difficult to investigate the reported violation and to obtain additional information. You may also provide a contact address where you wish to receive feedback on the measures taken.

First and last name of the alleged violator *

Location of the alleged violation *

Date of the alleged violation *

Time of the alleged violation *

Brief description of the alleged violation *

Please attach all available evidence (documents, invoices, etc.) related to your report.

Please inform me of the measures taken after the procedure is completed (in this case, provide a contact address under Reporter Details).

By submitting the report, you confirm that the information provided is truthful and that you are acting in good faith. False reports and unfounded accusations constitute an offense under Article 28 of the ZZPri.

Your report will be handled by the person responsible for receiving reports (the confidential officer). Detailed procedures for handling received reports of irregularities are defined in the internal regulation: Rules on Reporting Violations and Protection of Whistleblowers.