Whistleblower Reporting Form

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Whistleblower Reporting Form

All Bristol Community College stakeholders, including but not limited to employees, students, and community members, are encouraged to come forward with credible information on illegal practices or violations of adopted policies of the organization. Whistleblowers may be anonymous and will be protected from retaliation, in accordance with Bristol's Whistleblower Policy.

All reports of illegal and dishonest activities submitted on this form will be sent to the Head of Human Resources, who is responsible for investigating and coordinating corrective action. If your report is not anonymous, you may be contacted to provide further information on this report. Alternatively, individuals may also contact Office of the Inspector General Fraud hotline and/or find additional information for reporting directly to the state at mass.gov/service-details/whistleblowers-are-protected.

Fields marked with an asterisk (*) are required.

Date Filed:

Date(s) of Alleged Incident:

Additional Dates - Please enter dates here if there is more than one.

Name of Individual or Group in question:

Individual's or Group's relationship to Bristol Community College: (*)

Student

Employee

Community Member

Prefer not to state

Other

Provide information regarding this illegal practice or violation of policy. Please include as much detail as possible

that may assist in conducting an investigation, including any specific facts or documents.

If additional writing space is needed, please attach documents here:

Please note that the following fields are optional if you wish to remain anonymous.

Your Name: (Please note this is an optional field. If you provide a name, whenever possible, the confidentiality of the whistleblower will be maintained. However, an identity may have to be disclosed to conduct a thorough investigation, to comply with the law, and to provide accused individuals of their legal rights of defense. Please review the Whistleblower Policy for further information.)

First Name:

Last Name:

Email Address:

Phone Number:

Your relationship to Bristol Community College:

Student

Employee

Community Member

Prefer not to state

Other

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