1. Who is/was engaged in the possible act(s) of misconduct?  Provide name, title and any other relevant details.

First Name:
Last Name:
Title:

2. What happend?  Please provide the details of the possible misconduct.  Be as precise as possible.

Additional Information:

3. When was the possible misconduct committed?

4. Where was the possible misconduct committed?

Country:

Describe the location:

5. How was the possible misconduct perpetrated?  For example, were any checks, procedures or safeguards circumvented or violated to perpetrate the act(s)?

6. To your knowledge, WHY were the act(s) undertaken by the person who allegedly committed the misconduct?

7. Is there any specific evidence (e.g. documentation, witnesses) that you are aware of and how can they be located or contacted?

8. Please provide the contact details for OIOS to contact you:


First name:
Last Name:
Address:
Country:
Telephone:
Cellular Phone:
Email:
Fax:

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