You can use this web form to make a report if you suspect or have observed anyone associated with the IRC acting in a manner inconsistent with The IRC Way, IRC policies and procedures, or the law.

For all reports, please include as much detail as possible as reports that do not have enough detail for investigators to pursue may be closed.

After you make a report via this web form, you will receive a case number. You should use that number to regularly check back with EthicsPoint to see if the investigation team has asked you for additional information.

To make an anonymous report using the web form, click the "No" button for the first question on the form. After you click the "No" button, a new sentence will appear with a checkbox. Click the box next to "I would prefer not to give my name" and the identification fields below will disappear.

Items marked with a diamond ♦ are required fields.

Your Information (You, the person completing the form)

	♦ Are you completing this form on behalf of someone else (the reporter)? Yes No (Select One) I would prefer not to give my name. ♦ Are you a victim in this incident? Yes No (Select One)

Your Name &
Contact Information

Save “Your Name & Contact Information” for future use.

(By checking this box you agree to allow NAVEX to store your information in a “Cookie” on this computer.)

♦

First Name

♦

Last Name

Age

Gender

(Select One)

Phone Number

Include the area code, extension,
and/or dialing codes if applicable.

(Format: username@domain.com)

Position

(If not IRC staff please provide agency name.)

	♦ Relationship to Victim/Survivor IRC Beneficiary (Reporter is receiving humanitarian assistance from IRC.) (Select One)

Reporter (The person bringing this to the attention of IRC)

	The reporter prefers not to give their name. ♦ Is the reporter a victim in this incident? Yes No (Select One)

Reporter Name & Contact Information	♦ First Name ♦ Last Name Age Gender (Select One) Phone Number Include the area code, extension, and/or dialing codes if applicable. Email (Format: username@domain.com) Position (If not IRC staff please provide agency name.)

	♦ Relationship to Victim/Survivor IRC Beneficiary (Reporter is receiving humanitarian assistance from IRC.) (Select One)

Incident Details

Dates	♦ Date first reported to the IRC (Format: mm/dd/yyyy) Approximate date and time of issue/incident: ♦ Approximate Date of issue/incident. (Format: mm/dd/yyyy) Time (Select One of Each)

Details	♦ Country where incident occurred. ♦ Specific location where incident occurred. ♦ Description of Incident (Use short sentences and attach separate document if necessary.)

Action Taken	♦ Has there been an action already taken by the IRC regarding this incident? Yes No Unknown (Select One) ♦ Approximate date of previous action? (Format: mm/dd/yyyy) ♦ Describe the action previous taken.

Victim(s)

Victim(s)	♦ Are there any other victims related to this incident, other than those indicated above? Yes No (Select One)

Subject (of Complaint)

Subject(s)

Follow-Up & Password

Follow-Up	After you submit this report you will be issued a 12-digit “Report Key”. Using this report key and the password you create below, you will be able to access the Follow-Up functionality of this report. Follow-Up will allow you to: Upload/Attach documents to this report Respond to follow-up questions/comments Provide additional information

Password	Create a password to access the Follow-Up functionality of this report. ♦ Password ♦ Re-Enter Password (Passwords must be at least four(4) characters in length.)

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