1. What is the Regulated Entity?
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The company or organisation about which this disclosure is made is (tick each box which applies):
2. Am I an eligible whistleblower in relation to the regulated entity?
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I am (tick each box which applies):
3. Confidentiality and follow-up.
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How should the recipient refer to me?
Reminder: A qualifying disclosure can be made anonymously. Even if the qualifying disclosure is not made anonymously, an eligible whistleblower’s identity must in any case not be disclosed by the eligible recipient (unless the eligible whistleblower consents to this).
If the qualifying disclosure is made anonymously or if there is no consent to the identity being disclosed, the capacity to effectively investigate or take any action is reduced in any investigation by the regulated entity of the qualifying disclosure.
Do you consent to the recipient disclosing your identity or any information likely to lead to your identification?
I consent to the recipient contacting me for further information about the disclosure, or to provide feedback (at the discretion of the recipient)
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Please note you are unlikely to be contacted unless you have identified your full name
4. What are the details of the disclosure?
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Type of qualifying disclosure (check all that apply)
Who is the disclosure about (that is, who is the person or entity responsible for or engaging in the conduct this disclosure is about)?
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This can be about a corporate entity, or an officer or employee of the entity
Why would a reasonable person in my position would also suspect this disclosure involved misconduct or an improper state of affairs because? Reminder: Where the qualifying disclosure is about misconduct or an improper state of affairs, you must have reasonable grounds to suspect that conduct or state of affairs
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Set out reasons why another person in your position also suspect misconduct or an improper state of affairs?
Details of complaint
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Please describe what happened, in a way that identifies why the disclosure is about conduct that means it is a qualifying disclosure
Date/time period incident(s) occurred
Apart from you, did anyone witness the event/s?
Can the other witness/witnesses be contacted?
Please provide the name, position, email and phone number of the witness (if known)
Preferred method of contact for the witness (if known)
Have you or anyone else taken action in relation to the complaint? What action has been taken?
Has anyone else been informed of this complaint?
Can the person/s who have been informed of the complaint be contacted?
Please provide the name, position, email and phone number of the person/s who have been informed of the complaint
Preferred method of contact for the person who has been informed of the complaint (if known):
Is there anything else you wish to add that would assist the Company to make an assessment of the conduct or to otherwise investigate it.
To the best of my knowledge, this disclosure is not about circumstances which are a personal work-related grievance.
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Reminder: A personal work-related grievance is not a qualifying disclosure except in limited circumstances. A description of what is a personal work-related grievance can be found in the policy at this link: https://www.marlinbrands.com.au/whistleblower-policy
