EmailMe Form - KU Children's Service Whistleblower Disclosure For

Are you aware of/Have you read the KU Whistleblower policy? *

I am aware and have read the policy

I am aware but have not read the policy

I am not aware of and have not read the policy

Do you wish to have this whistleblower disclosure handled internally by the organisation? *

Yes - The matter will be managed within KU

No - The matter will be managed by the external WBS

I would like to raise an anonymous concern:

No

If you do not wish to remain anonymous please provide your details below.

Name

First Last

Phone Number

Email Address

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

I would like to raise an anonymous concern:

Yes

Please note, a concern being anonymous may affect our ability to address concerns.

I am providing an anonymous concern, please select an option:

I do not wish to provide my name

I will provide my name but do not want it provided to any third parties

Please note that we are legally obliged to provide any information regarding certain conduct such as, criminal conduct, to external authorities including the Police or relevant Child Protection agencies.

Are you completing this form on behalf of another person?

Yes

No

If yes, please provide your details below

Name

First Last

Phone Number

Email Address

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

What is the relationship of the whistleblower to the person making the whistleblower disclosure? *

Professional

Personal

The Nature of the Concern

Who is this concern regarding? *

If other, please specify

If known, please provide the name of the person to whom this concern is regarding:

Please provide details of the concern. If possible, list:
* The alleged improper conduct as specified in the Whistleblower policy
* Who was involved?
* When did it occur?
* What are the grounds for believing that the conduct occurred? *

Will you send (other) supporting documents by mail or email?

Yes

No

If you have additional information or would like to send supporting documents by email, please send to KUwhistleblower@integroe.com.au

Please upload any evidence or supporting documentation

If you have indicated that you would like to provide or speak with someone to provide information, please ensure that you provide a contact number below:

Thank you for taking the time to raise these concerns.

Single Line Text

Name

First Last