Here’s a detailed SayPro Integrity Breach Reporting Form template designed for documenting and reporting any breaches of integrity within SayPro’s operations:
SayPro Integrity Breach Reporting Form
Purpose:
To provide a standardized process for reporting suspected or confirmed breaches of SayPro’s integrity standards, ensuring timely investigation and resolution.
Instructions:
Please complete this form with as much detail as possible. All reports will be handled confidentially. If you prefer, you may submit anonymously.
Section 1: Reporter Information
(Optional if anonymity is preferred)
- Name: __________________________________________
- Position/Role: ___________________________________
- Contact Information (email/phone): ________________
- Relationship to SayPro (Staff, Partner, Beneficiary, Other): ____________
Section 2: Details of the Breach
- Date and Time of Incident:
- Location (Office, Program, Project, etc.):
- Description of the Breach:
(Provide a detailed account of the incident or concern)
- Integrity Standard(s) Violated:
☐ Conflict of Interest
☐ Corruption / Bribery
☐ Fraud
☐ Data Privacy Breach
☐ Abuse of Power
☐ Discrimination / Harassment
☐ Other (please specify): __________________________
- Individuals Involved:
(Names and roles, if known)
- Witnesses:
(Names and contact information, if known)
Section 3: Reporting and Follow-Up
- Have you reported this incident previously?
☐ Yes
☐ No
- If yes, to whom and when?
- Additional Evidence or Documentation:
(Attach any relevant documents, emails, photos, etc.)
Section 4: Confidentiality and Protection
- Are you requesting confidentiality for your report?
☐ Yes
☐ No
- Do you wish to receive follow-up communication regarding this report?
☐ Yes
☐ No
Section 5: Declaration
I declare that the information provided is true and accurate to the best of my knowledge.
- Name: ___________________________
- Date: ____________________________
- Signature (if submitting in person): ________________________
Thank you for your courage in reporting this issue. SayPro is committed to thorough investigation and appropriate action.
Would you like me to help create a digital fillable version or guidance notes on how to handle submitted reports?