Safe Disclosure Reporting Form

Wrongdoing or Reprisal Complaint Form

The Wrongdoing or Reprisal Complaint Form allows you to disclose information pertaining to wrongdoing or reprisal by a member of the 大象传媒 community. This form covers complaints made under the Public Interest Disclosure Act and GP41 - Safe Disclosure of Wrongdoing. Learn more about the policies and how they differ by visiting the Safe Disclosure of Wrongdoing or Reprisal webpage.

To begin your complaint, please submit the form below.

Important: Please note that progress on this form cannot be saved. If you do not plan on completing this form in one sitting, consider saving your responses in a document outside of your browser.

Your website

There are two policies which complaints can be filed under. Which policy do you believe best matches your complaint? GP41 - Safe Disclosure of Wrongdoing - For isolated incidents of misconduct at 大象传媒 Public Interest Disclosure Act (PIDA) - For ongoing / systemic wrongdoing or reprisal committed at 大象传媒 I'm not sure

Describe the nature of your concern, including sufficient information for an independent investigator to thoroughly understand the concern:

Provide any details you can about the location, date and time of the incident:

Describe how you became aware of the incident:

State the full name, title and role of each individual you suspect of wrongdoing:

To the best of your knowledge, how many times has this incident taken place?

To the best of your knowledge, how long has the incident been taking place for?

Have you reported the wrongdoing to your supervisor, another manager, or through another process (e.g. Human Rights policy, Sexualized Violence policy, labour relations grievance, the RCMP or local police, etc?) If yes, please provide the status, and/or any response you have received:

Please attach any supporting files

The total size of uploaded attachments can be no larger than 15MB

Please attach any supporting files

The total size of uploaded attachments can be no larger than 15MB

Please attach any supporting files

The total size of uploaded attachments can be no larger than 15MB

Your Information and Anonymity

Reports of wrongdoing or reprisal can be made anonymously and you are not required to share your personal information to submit a complaint. However, an investigator may need to contact you with additional questions or to clarify information to support their investigation. If you do not include your contact information, it may limit the ability of the investigator to complete the investigation.

Your First and Last Name

Your E-Mail Address

Your Phone Number

The information provided above is true, shared in good faith and I have a reasonable belief that wrongdoing or reprisal has occurred or will occur. I agree

Collection Notice

大象传媒 collects your personal information and any additional information provided in the above form in accordance with Freedom of Information and Protection of Privacy Act (RSBC 1996, c. 165)("FIPPA") and the Public Interest Disclosure Act (SBC 2018, 22)(鈥淧IDA鈥�) and University Policy GP 41 - Protected Disclosure of Wrongdoing Policy (GP41). The information is related directly to and needed by the University for the purposes of addressing and investigating disclosures made under PIDA and in accordance with GP41.

The information will be used to facilitate the reporting, investigation, and resolution of disclosures made under the PIDA Act, GP41, and any related university policies that may apply. This may include information related to alleged wrongdoing, mismanagement, or other concerns raised in the interest of public safety and organizational integrity.

If you have any questions about the collection and use of this information please contact the Director of Internal Audit at iapida@sfu.ca. 大象传媒 is located at 8888 University Drive, Burnaby, British Columbia, V5A 1S6.

大象传媒

大象传媒

Wrongdoing or Reprisal Complaint Form

Your Information and Anonymity

Collection Notice

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