GSWPA Whistleblower Form

Girl Scouts Western Pennsylvania Whistleblower Policy
Do not use this report if the event you are reporting presents an immediate threat to life or property. Reports submitted through this venue may not receive an immeidate response. If you require emergency assistance, please contact your local authorities.
Select the location where the incident occurred:*

Camp Conshatawba - 288 Oaks Road, Summerhill, PACamp Hawthorne Ridge - 7755 Hawthorne Ridge Road, Girard, PACamp Redwing - 103 Rader School Road, Renfrew, PACamp Skymeadow - 164 Skymeadow Lane, Avonmore, PACorporate Office - 503 Martindale Street, Suite 500, Pittsburgh, PAEdinboro Office - 5681 Route 6N, Edinboro, PAGreensburg Office - 126 East Otterman Street, Greensburg, PAJohnstown Office - 612 Locust Street, Johnstown, PAKittanning Office - 2359 Freeport Road, Kittanning, PAOther/Do Not Know/Not Listed
Choose the type of report you would like to make:*

Accounting & Auditing (The unethical systematic and analysis of the business and financial transactions associated with generally accepted accounting practices. (Examples include: misstatement of revenues, misstatement of expenses, misstatement of assets, misapplications of GAAP principles, wrongful transactions.)Disclosure of Confidential Information (Unauthorized and unlawful disclosure of corporately owned intellectual property or trade secrets, as well as employee, customer or consumer information, marketing and other corporate data bases, marketing plans, business proposals and strategies.Donor Stewardship (Funds directed to the organization have not been handled with the utmost truthfulness or not used in accordance with the donor's intentions and wishes. Failure to provide due care with respect to the donor, and/or donation. Injury to the public trust.Falsification of Contracts, Reports or Records (Falsification of records consists of altering, fabricating, falsifying, or forging all or any part of a document, contract or record for the purpose of gaining an advantage, or misrepresenting the value of the document, contract or record.Theft (The act of stealing: specifically: the felonious taking and removing of personal property with intent to deprive the rightful owners of it.Other (If you feel that the definitions above do not describe the event, action or situation you are looking to report about, please use this option.)
Are you an employee of Girl Scouts Western Pennsylvania?*

YesNo
Do you wish to remain ANONYMOUS for this report?*

YesNo
If you want Girl Scouts Western Pennsylvania to know your identity, please complete the following:

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Best time for communication with you:
Please identify the person (s) involved in the alleged incident or violation including First Name, Last Name, Title.
Do you suspect or know that an employee of Girl Scouts Western Pennsylvania is involved?*

YesNoDo Not Know/Do Not Wish to Disclose
If yes, then who?
Is management aware of this problem?*

YesNoDo Not Know/Do Not Wish To Disclose
If yes, then who?
First Name/Last Name
What is the general nature of this matter?*
This should be a general description only. You will be asked for specifics later.
Where did this incident or violation occur?*
We recognize that this incident may not have occurred in a particular location. However, if this incident was observed in some documentation or business transactions, please indicate this accordingly.
Please provide the specific or approximate time this incident occurred.*
Example: Tuesday, May 3, 20XX, Two Weeks ago, Approximately a month ago.
How long do you think this problem has been going on?*
How did you become aware of this incident or violation?*
Please identify any persons who have attempted to conceal this problem and the steps they took to conceal it, if applicable.*
Example: Ignored it, Changed documents, Said it was not a problem, Said they would look into it.
Please provide all details regarding the alleged incident or violation, including the locations of witnesses and any other information that could be valuable in the evaluation and ultimate resolution of this situation.*
Please take your time and provide as much details as possible, but exercise care to not provide details that may reveal your identity unless you wish to do so. It may be important to know if you are the only person aware of this situation.
Should be Empty:

Girl Scouts Western Pennsylvania Whistleblower Policy