The Office of the Chief Inspector General


Whistle Blower's Hotline logo The Whistle Blower Complaint Form
 


Are you a:








       
* Indicates that this agency's Inspector General will accept this Whistle-blower Complaint directly.



Are you reporting:

a. Alleged violation(s) or suspected violation of any federal, state, or local law, rule or regulation committed by an employee or agent of any agency or independent contractor which creates and presents a substantial and specific danger to the public's health, safety or welfare?





Who is the employee or agent that committed the alleged violation or suspected violation?

What is the employee or agent's position title?
When did the alleged violation or suspected violation occur? (mm/dd/yyyy)

b. Alleged act or suspected act of gross mismanagement, malfeasance, misfeasance, gross waste of public funds, suspected or actual Medicaid fraud or abuse, or gross neglect of duty committed by an employee or agency of any agency or independent contractor?
Yes No

If yes:

What is the alleged act or suspected act?


Who is the employee or agent that committed the act or suspected act?

What is the employee or agent's position title?

When did the alleged act or suspected act occur? (mm/dd/yyyy)

If you checked yes in a. or b. above, you may meet the specific criteria outlined in statute to be designated as a whistle-blower. Please provide the specific details of the allegation(s) or violation(s). Include any witness' names and description and location of any supporting documentation you may have or know of to support your complaint.

Have reported the above to:

a supervisory official in writing
the Chief Inspector General in the Executive Office of the Governor
the Chief Inspector General's staff via the Whistle-blower's Hotline
an agency Inspector General or staff member (orally or in writing)
the Florida Commission on Human Relations (orally or in writing)
Or
Reporting this now for the first time

Did you disclose allegations or violations (as referenced in a. or b.) while participating in an investigation, hearing, or other inquiry conducted by any agency or federal government entity? Yes No

Did you refuse to participate in any adverse action prohibited by the Whistle-blower's Act? Yes No

By selecting "Yes" I am acknowledging that my complaint and any other preliminary information available alleging a possible prohibited or retaliatory personnel action against me may be forwarded to the Florida Commission on Human Relations, without redaction, pursuant to Section 112.31895(1)(b), Florida Statutes. Selecting “No” may prevent the Office of the Chief Inspector General from forwarding my complaint and any other preliminary information alleging possible workplace retaliation against me to the Florida Commission on Human Relations for investigative purposes. Yes No


Your complaint will be reviewed and assessed upon receipt and someone in either the Agency Inspector General's Office or the Chief Inspector General's Office will advise you in writing of whether your complaint meets statutory requirements to be designated as a whistle-blower complaint. A determination will also be made whether the complaint warrants investigation by the Inspector General, or whether a referral to another entity (such an management) is more appropriate. The more specific information that you provide, the better we are able to assist you.

Please select who you would like to send this information to :
My Agency's Inspector General (if accepting these forms)
The Chief Inspector General


  








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