Misconduct report form

Contact information

Name of the person making the report *

Email address of the person making the report *

Organisation of the person making the report *

Contact person's job title *

Contact person's telephone number *

Does the report concern suspected misconduct within activities that receive funding from the Ministry of Foreign Affairs? *

Date of this report

mm/dd/yyyy

Report of misconduct

Within which team/core activity did the reported misconduct occur? *

If the suspected misconduct did not take place in the Netherlands, in which country/countries did it occur?

Date of (first) incident: *

mm/dd/yyyy

When did you first become aware of the suspected misconduct? *

Type of misconduct *

Interpersonal violations (unwanted sexual advances, sexual harassment and sexual violence; aggression, discrimination and bullying)

Financial violations (fraud; improper use/misuse of resources; theft; tax avoidance and asset management/investment policy contrary to the organisation's objective)

Abuse of power (corruption; conflicts of interest and nepotism; manipulation or misuse/leaking of information;)

If possible, give a brief description of the suspected misconduct *

Consideration

Why do you consider the suspected misconduct to be serious? *

Other relevant information

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After you submit the form, you will receive a copy by email. Please retain this email for your own reference.

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