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Whistleblower Investigation Form

A whistleblower investigation form is the vigilance officer's working document for handling a protected disclosure. It assesses whether the disclosure falls under the policy, records identity-protection steps, defines the investigator's mandate, plans evidence collection, and summarises findings for the audit committee.

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[Company Logo][Company Name]

WHISTLEBLOWER INVESTIGATION FORM

Disclosure Code:: [Reference Number]
Date Received:: [Date]
Vigilance Officer:: [Name]
Classification:: Strictly Confidential

1. Preliminary Assessment

Summary of disclosure (without whistleblower identity)
Falls within vigil mechanism policy? (Yes/No, reason)
Seriousness: High / Medium / Low
Involves director or senior management? (if yes, inform Audit Committee Chair)
Decision: Investigate / Refer to another forum / Close (reason)

2. Identity Protection

Whistleblower identity stored separately and accessible only to the Vigilance Officer
Disclosure code used in all documents
Investigator briefed not to attempt to identify an anonymous whistleblower
Monitoring for victimisation arranged

3. Investigator Mandate

Investigator(s) name and organisation
Independence confirmed (Yes/No)
Scope of investigation
Target completion date

4. Evidence Plan

Evidence	Custodian	Preservation Step	Date Secured
[Accounts / ledgers]	[Finance]	[Read-only copy]	[DD/MM/YYYY]
[Emails]	[IT]	[Mailbox hold]	[DD/MM/YYYY]
[Vendor records]	[Procurement]	[Copy]	[DD/MM/YYYY]

5. Subject's Response

Subject informed of allegations on
Response received on
Summary of response

6. Findings and Recommendation

Findings on each allegation (substantiated / not substantiated / inconclusive)
Recommended action
Control or process improvements

7. Closure

Reported to Audit Committee on
Feedback given to whistleblower on
Case closed on

Investigator
[Name]
Date: [Date]

Vigilance Officer
[Name]
Date: [Date]

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What this template includes

Preliminary assessment of scope and seriousness
Identity protection measures for the whistleblower
Investigator mandate and independence
Evidence collection and document preservation plan
Opportunity for the subject to respond
Findings and recommended action
Reporting to the audit committee and feedback to the whistleblower

When to use it

A protected disclosure has been received through the vigil mechanism
The vigilance officer must decide whether a disclosure warrants investigation
An external forensic auditor or internal audit team is appointed
The audit committee needs a status and findings summary

How to customise this template

1Assign a disclosure code instead of using the whistleblower's name
2Add forensic, legal or IT experts in the investigator section where needed
3Insert your audit committee reporting frequency
4Include data-preservation instructions for IT
5Keep this form apart from HR personnel files

HR tips

Preserve documents and data quietly before alerting the subject
The subject must still get a fair chance to respond to allegations
Use 'no evidence found' rather than 'false' unless malice is proved
Give the whistleblower general feedback without disclosing confidential details

This template is a starting point. Review it against company law vigil mechanism requirements, listing rules where applicable, your whistleblower policy and with legal or forensic advisers.

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Frequently asked questions

Who investigates a whistleblower complaint?+

The vigilance officer, or an investigator appointed by them or the audit committee, who must be independent of the people involved.

Is the subject of a whistleblower complaint told about it?+

Yes, at an appropriate stage. They must be informed of the allegations and given an opportunity to respond, usually after key evidence is preserved.

What feedback does the whistleblower get?+

Usually a confirmation that the matter was examined and closed, without sharing confidential findings or action against others.

All 50 employee relations & grievances →

[Company Logo][Company Name]
GRIEVANCE INVESTIGATION FORM
Case No.:
[Reference Number]
Date Opened:
[Date]
Classification:
Strictly Confidential
Part 1: Case Details
Complainant [Employee Name], [Employee ID], [Department]
Respondent (if any): Name, Designation, Department
Date grievance received
Grievance category
Part 2: Terms of Reference
Issue 1 to be investigated
Issue 2 to be investigated
Issue 3 to be investigated
Matters outside scope (if any)
Target completion date
Part 3: Investigator Appointment and Independence
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[Company Logo][Company Name]
INVESTIGATION INTERVIEW RECORD
Case No.:
[Reference Number]
Date:
[Date]
Time:
[Start] to [End]
Venue / Mode:
[Meeting Room / Video Call]
Interview Details
Interviewee name and Employee ID
Designation / Department
Role: Complainant / Respondent / Witness
Investigator(s)
Note-taker
Companion or translator present (name)
Opening Statement (read to interviewee)
Thank you for meeting us. We are investigating [neutral description of issue] under case number [Reference Number]. No decision has been made. We are speaking to everyone relevant to understand the facts. Please answer honestly and tell us if you do not know or do not remember. This discussion is confidential, and we ask you not to discuss it with colleagues. The company does not allow anyone to be treated unfavourably for taking part in an investigation; if this happens, please tell HR immediately. Do you have any questions before we begin?
Questions and Answers
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[Company Logo][Company Name]
PROTECTED DISCLOSURE / WHISTLEBLOWER COMPLAINT
To:
Vigilance Officer, [Company Name] / Chairperson, Audit Committee
Reference No.:
[Reference Number]
Date:
[Date]
This disclosure is made under the company's Whistleblower / Vigil Mechanism Policy. Mark the envelope 'Protected Disclosure – Confidential' or email [Vigilance Email]. Your identity will be protected.
1. Whistleblower Details (kept separately and confidential)
Name
Employee ID
Designation / Department
Safe contact
I wish to remain anonymous (Yes / No)
2. Nature of Wrongdoing
- Financial fraud or misappropriation
- Manipulation of accounts or records
- Violation of law or regulation
- Falsification of safety, quality or test data
- Abuse of authority
- Leak of confidential or price-sensitive information
- Other serious wrongdoing
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[Company Logo][Company Name]
EMPLOYEE GRIEVANCE FORM
Company:
[Company Name]
Grievance Case No.:
[Reference Number]
Date of Submission:
[Date]
Use this form to formally raise a work-related grievance. Please write clearly and attach any supporting documents. Complaints of sexual harassment must be submitted to the Internal Committee under the company's POSH policy and not on this form.
Section A: Employee Details
Employee Name
Employee ID
Designation
Department
Work Location
Reporting Manager
Mobile Number
Official Email
Section B: Nature of Grievance
- Salary, wages, overtime or deductions
- Leave or attendance
- Working conditions, shift or safety
- Transfer, promotion or appraisal
- Interpersonal issue with a colleague or manager
- Application of a company policy
- Other (please specify)
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Employee Grievance Form
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[Company Logo][Company Name]
EMPLOYEE COMPLAINT FORM
Company:
[Company Name]
Complaint No.:
[Reference Number]
Date:
[Date]
This form is used to report conduct that you believe breaches company rules or the code of conduct. All complaints are treated confidentially. If your complaint relates to sexual harassment, please approach the Internal Committee directly as per the company's POSH policy.
1. Complainant Details
Employee Name
Employee ID
Designation
Department
Work Location
Contact Number
Preferred mode of contact
2. Person(s) Complained Against
Name
Designation / Role
Department or Organisation (if vendor/customer)
Relationship to you (colleague, supervisor, vendor, other)
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[Company Logo][Company Name]
GRIEVANCE INVESTIGATION REPORT
Case No.:
[Reference Number]
Report Date:
[Date]
Prepared by:
[Investigator Name], [Designation]
Submitted to:
[Decision Maker Name]
Classification:
Strictly Confidential
1. Executive Summary
This report sets out the investigation into the grievance raised by [Employee Name], [Designation], on [Date]. Of the [Number] issues investigated, [Number] were substantiated, [Number] were not substantiated and [Number] were inconclusive.
2. Background and Terms of Reference
[Brief neutral description of the grievance.] The investigator was appointed on [Date] by [Name] to examine: (a) [Issue 1]; (b) [Issue 2]; (c) [Issue 3].
3. Methodology
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[Company Logo][Company Name]
WORKPLACE COMPLAINT FORM
Site / Unit:
[Work Location]
Form No.:
[Reference Number]
Date:
[Date]
Anyone working at this site may use this form. You may give your name or leave it blank. For complaints of sexual harassment please contact the Internal Committee: [IC Presiding Officer Name], [Phone].
About You (optional)
Name
Employee ID / Gate Pass No.
Category: Employee / Contract Worker / Trainee / Apprentice
Contractor Company (if applicable)
Department / Line
Shift
Contact Number
Type of Complaint
- Safety hazard or unsafe practice
- Washroom, drinking water or hygiene
- Canteen or food quality
- Transport or shuttle
- Wages, overtime or deductions
- Behaviour of a person
- Equipment, PPE or tools
- Other
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Workplace Complaint Form
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[Company Logo][Company Name]
WORKPLACE CONFLICT FORM
Company:
[Company Name]
Form No.:
[Reference Number]
Date:
[Date]
1. Submitted By
Name [Employee Name]
Employee ID [Employee ID]
Designation / Department
Submitting as: Party to the conflict / Manager / Other
2. Parties Involved
Name Designation Department Working Relationship
[Employee Name] [Designation] [Department] [Peer / Reports to / Cross-team]
[Employee Name] [Designation] [Department] [Relationship]
3. Nature of Conflict
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