Whistle blowing policy

This form is for any individual working with or for Genesis Analytics (including staff, suppliers, sub-contractors, partners, vendors and clients) who wishes to raise an issue about wrongdoing in the firm. Staff can refer to the Whistle Blowing Policy on the Resource Site for more details regarding this.

Name:

Optional

Relationships to Genesis:

Telephone / Mobile No:

Optional.

E-mail / ID:

Optional.

Personal involvement / personal interest:

Please declare any personal interest you may have in this matter (i.e. does the outcome of this matter have the potential to affect you personally in any way?)

Have you been personally involved in this matter previously?

If YES, please outline your involvement.

Expressed preferences:

Do you wish your concern to be treated in confidence?

Yes

Are you willing to participate with any further enquiries into this matter or formal investigation?

Yes

Date:

Summary of disclosure:

(Please set out the details of the issue that you wish to raise, providing examples where possible, particularly dates, times, locations and the identities of those involved. You may attach additional sheets if required. If you are not providing your details, it is important to give as much detail as possible, so we can take it forward appropriately)

Individuals involved:

Please provide the names and contact details of any people involved in your concerns, including witnesses.

Declaration:

I confirm that the above statements are true to the best of my knowledge, information and belief. I understand that, if I knowingly make false allegations, this may result in Genesis or others taking disciplinary action against me. Yes/No

Yes

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