This form is designed to provide AVA Care & Case Management, employees, faculty, and others with a method to anonymously report crimes or allegations of Misconduct. You are not required to complete the entire form to submit it, but you are required to submit the form in good faith, with information that is true and accurate to the best of your knowledge. Anonymous reports will be investigated, however, the organizations response may be limited depending on the information provided.

Be advised that anyone who is or can be identified by the information provided may be contacted by senior management as part of the investigation, and that some or all of the information provided may be shared with the person(s) being accused of committing crime or Misconduct. If you do not want to be identified, omit your personally identifiable information throughout the form. If the person completing this form is a third party who is not the victim, do not include any personally identifiable information about the victim unless you have the victim’s express permission to disclose his or her identity.

Anonymous Workplace Misconduct Form

  • (Optional) This form is designed to give you an opportunity to report a conduct violation anonymously. However, if you are comfortable with speaking to senior staff members regarding this incident please provide your name.