An Easy Way to Measure Workplace Culture

What is your company?

1. What is your relationship with this Company?

2. What type of incident/issue would you like to report?

3. Please describe the issue or incident you are reporting:

Please be as detailed as possible to assist the evaluation of this situation. Please take your time and exercise caution not to provide details that may reveal your identity if you wish to remain anonymous.

4. When did the incident occur?

5. Who was involved in this incident?

6. Was anyone from senior management involved in this incident?

7. At what specific location did this incident occur?

8. Have there been repeated examples of this incident?

9. Has the incident been reported internally to management or anyone in the Company?

10. Has the incident been reported to anyone outside of the Company?

11. Where there any witnesses to the incident?

12. Are you willing to be contacted to provide more information?

First Name

Last Name

Phone Number

Email Address

Right Workplace LLC is an independent provider that assists your Company in the identification of improper activity. We are committed to protecting the anonymity of all persons who use our reporting system. Reports are submitted by Right Workplace systematically to the Company’s assigned reviewer, and may or may not be investigated at the sole discretion of the Company. While we will not disclose your identity without your permission, it is possible that your identity may be discovered during an evaluation of the matter because of information you have provided.

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Whistle Blower Line

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