Statement of Purpose

The Employee Relations (ER) Incident Report Form is intended for use by HR Professionals to capture any reported concern or incident involving a violation or potential violation of our Code of Conduct Policy, Company policy or the law. Use this form to document matters which meet the descriptions identified in the drop down list provided on this form. This will provide the Company with relevant data to assist in appropriately managing employee relations with our employees, our most important asset.

Please submit all incident reports within 24 hours of report. The details of your submission can only be accessed by authorized users. You may be contacted for additional information after further review of your submission. Privileged and Confidential.

Items marked with a diamond are required fields.
Your Information (You, the person completing the form)
Name & Contact Information
Saved Data
(By checking this box you agree to allow NAVEX Global to store your information in a Cookie on this computer.)

 
Select One
 

 

Include the area code, extension, and/or dialing codes if applicable.
 
Include the area code, extension, and/or dialing codes if applicable.
Format: username@domain.com

Reported By (The person who brought this incident to the company's attention)
Reporter
Select One

Location (Where the incident took place)
Location
Click the button labeled Look-Up to locate and select a location. If the location you are looking for is not available, select the location labeled Other / Not Listed, and then enter the location information in the form manually.
 

 
 

 
 
 
 
 

 
Issue Selection  
Category
Select One
Description
Incident Details (Privileged and Confidential)
Date

Format: mm/dd/yyyy
Details
 
Previously Reported
Select One

Participants (Including but not limited to Implicated Persons, Accomplices, and/or Witnesses)
Participants
Select One
Action Taken
Action Taken
Select One

File Upload
File Upload
 
Here you can upload files and documents for the company to review that are related to this report.



 

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.

(Passwords must be at least four(4) characters in length.)

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