WHISTLEBLOWER REPORT ONLINE FORM

(This section may be left blank if the reporter wish to remain anonymous)

1
REPORTER’S CONTACT INFORMATION
2
SUSPECT'S INFORMATION
3
WITNESSES' INFORMATION (if any)
4
DISCLOSURE

1/4

REPORTER’S CONTACT INFORMATION

(This section may be left blank if the reporter wish to remain anonymous)

Name

Designation

Department

Contact Number

Email

Name

Designation

Department

Contact Number

Email

Name

Designation

Department

Contact Number

Email

Please include
(i) background and history of concern (What, Who, When, Where, How) and
(ii) evidence (if any) to support the claim. - Insufficient details in the whistleblowing report may delay the investigation and outcome of the concerns raised.

Details*

Evidence / Supporting Document(s) (Kindly ensure that each document have a different filename)

File 1 (PDF format file type not more than 2Mb)

File 2 (PDF format file type not more than 2Mb)

File 3 (PDF format file type not more than 2Mb)

Consent
I hereby declare that all the information given herein are made voluntarily and true to the best of my knowledge. Institut Jantung Negara (IJN) Sdn. Bhd. will use the information and material(s) provided in the course of managing the disclosure/complaint

Whistleblower report Online Form

Report any concerns
confidentially