Reporting form unethical behaviour

1. What kind of incident(s) do you want to report?

Otherwise, i.e.

2. When and where did the incident(s) occur?

Location and date

3. Did the incident(s) involve a person participating in a project or activity implemented or funded by the Liliane Foundation and MIVA or did it concern a person working for/with the Liliane Foundation and MIVA?

No, i.e.

4. If the incident(s) concerns a (strategic) partner organisation of the Liliane Foundation and MIVA, which organisation and in what country?

5. What is the position of the person(s) causing the incident(s)?

Otherwise, i.e.

6. Which person(s) is/were involved in the incident(s)?

Please provide us with the name(s) or description of the person(s) involved. Do this also if it concerns an incident concerning a child. Please provides us with information if he or she has a disability and/or has special needs.

7. What happened?

Describe in your own words what occurred. Provide a summary focusing on the facts.

8. Have any action(s) been taken immediately after the incident(s) occurred?

Please describe shortly which action(s) have been taken.

9. Do you have any documentation concerning the incident(s) that you can share with us?

File

Max. file size: 64 MB.

10. Are you filing this report on behalf of someone else?

11. What is your own connection to the Liliane Foundation and MIVA?

Otherwise, i.e.

12. We might need more information to be able to take proper action. Would you allow us to contact you?

13. Do you wish to remain anonymous?

14. Do you wish to stay informed on any action taken by us in follow up to this report?

If you wish to stay informed, we will need your contact details. Please provide your contact details below. You may also want to provide us with a temporary email address if you still want to remain anonymous.

15. What is your name?*

First Last

16. What is your email address that we can use to contact you?*

17. What is your telephone number that we can use to contact you?

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