WHISTLEBLOWER

KLK Whistleblower

1. k

   1. Which company/branch would you like to report?
      Company / branch name *
   2. Address of the company/branch?
      Section *
      Address *
      Town *
   3. I am a:
      ClientContractorSupplierEmployeeOther
   4. Are you willing to provide your name?
      I prefer to remain anonymousMy name and contact details are:
      

2. .
   1. Please indicate the most appropriate description of the incident you wish to report:
      Fraud (including: wrongful falsification of original in order to cheat, falsification of documents/claims, identity fraud)Misconduct (including: sexual harassment, any form of descrimination, intimidation, misuse of authority, misappropriation of company assets)Unethical Behavior (including: prejudice, nepotism, violation of company policy, conflict of interest)TheftCorruption (including: any form of bribery, conspiring with third parties)Other

3. .

   1. Do you know the name of the person or the branch / section / company involved?
      Yes
      If yes, please provide the name of the person, branch and section.
      Branch:
      Section:
      Person's name:
      No
   2. Are there any other parties involved which you would like to mention?
      Yes
      If yes, please provide the person's name.
      Person's name:
      No
   3. Has management been informed?
      YesNo

4. .

   1. When did the incident occur?
      
   2. Where did the incident occur?
      
   3. How do you know about the incident?
      
   4. Is there any supporting evidence/information available?
      
   5. Could you please describe the incident in detail.
      Provide as much information as possible, provide the time, date, place and name where possible.
      WHO is involved? WHAT did the person do? WHERE? WHEN? HOW?
      
   6. Do you know if the incident is stil occuring?:
      Yes, within 24 hoursYes, after 24 hoursNo, it will not occur againI don't know

   The following communication channels are available should you wish to make use of them
   (with the option to remain anonymous should you wish to do so):

   Grandville Marquard at +27 54 337 6212
   fax number: +27 86 540 7800

   fluitjieblaser@klk.co.za

   * Please make sure that you complete the following fields!