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Whistleblower report form

Let someone raise a serious concern in writing, with room for evidence and a confidentiality choice.

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Whistleblower report

Made to: Marlow Engineering Ltd, for Head of Compliance
Date of report: 12 September 2027

About you

Name given: Do you want to give your name
Name: Jonas Weber
Contact: A private email address: jonas@example.com
Link to the organisation: Employee in the Purchasing team

The concern

Kind of concern: Kind of concern

What happened

Since March, orders for one supplier were approved without quotes, and prices are about 30 per cent above others.

When and where: March to August 2027, Head Office

Who is involved

A purchasing manager and the supplier's sales contact

Evidence

Three purchase orders and an email, attached

Who else has been told: Nobody

Our promise

  • Your report goes only to Head of Compliance and those who must act on it.
  • We will not reveal who you are unless the law requires it or you agree.
  • You will not be treated badly for a report made in good faith, even if it turns out to be mistaken.
  • We will tell you the report was received and what happens next, if you gave a way to reach you.

I make this report in good faith and believe what I have written is true.

Signature (if named): ______________________

For the organisation

Reference number: ______________ Received on: ______________
Received by: ______________________
Action taken and outcome: ________________________________________
Reporter told on: ______________

Templates are a careful starting point, not legal advice. Where the law matters, check what applies where you are.

Company and legal

What this template is for

A whistleblower report form for staff, suppliers and others to raise a concern: what happened, who is involved, evidence, confidentiality and a handling record.

It is free to fill in online, needs no account, and downloads as a Word document or a PDF. See all Company and legal templates

Company and legal

What you fill in

The form asks for 13 details. The document fills itself in as you type.

  • Organisation the report is made to

    For example: Marlow Engineering Ltd

  • Report goes to

    For example: Head of Compliance

  • Do you want to give your name

  • Your name (optional)optional

    For example: Jonas Weber

  • How we can reach you (optional)optional

    For example: A private email address: jonas@example.com

  • Your link to the organisation

    For example: Employee in the Purchasing team

  • Kind of concern

  • What happened

    Facts first: what, where, how often.

    For example: Since March, orders for one supplier were approved without quotes, and prices are about 30 per cent above others.

  • When and where

    For example: March to August 2027, Head Office

  • Who is involved

    For example: A purchasing manager and the supplier's sales contact

  • Evidence you have (optional)optional

    Do not break rules or the law to get evidence.

    For example: Three purchase orders and an email, attached

  • Who else you have told (optional)optional

    For example: Nobody

  • Date of report

    For example: 12 September 2027

Company and legal

What is inside

The parts of this document, in order.

  1. 1About you
  2. 2The concern
  3. 3Evidence
  4. 4Our promise
  5. 5For the organisation

Templates

How it works

  1. 01

    Fill in

    Type your details in the form. The document fills itself in as you type; click any gap to jump to its field.

  2. 02

    Check

    Read it through. Gaps you have not filled stay marked, so nothing goes out half done.

  3. 03

    Download

    Save it as a Word document to edit further, or as a PDF to send or print.

Make it yours with AI

Open it in the chat and ask for changes: shorter, firmer, another situation, another language.

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Company and legal

Questions people ask

What details does this template ask for?

The form asks for 13 details, starting with Organisation the report is made to, Report goes to, Do you want to give your name, Your link to the organisation, Kind of concern. 4 more are optional.

Can I download this template as Word or PDF?

Yes. When you have filled in the form, save it as a Word document to keep editing, or as a PDF to send or print. It is free and needs no account.

Is what I type sent anywhere?

No. What you type stays in your browser while you fill in the document. It only goes to nerix if you choose to open the template in the chat.

What should I check before I use this template?

Many countries protect people who report wrongdoing in good faith and set who must receive and handle reports. Check the rules where you operate and follow your whistleblowing policy. Not legal advice.

Are these company templates free?

Most are. Fill in and download them for free as Word or PDF, with no account. A few longer documents are premium: free to fill in, paid once to download, and marked with their price.

Is a template the same as legal advice?

No. A template is a careful starting point. Company, contract and data protection law differ by country, so have a lawyer read anything that carries real risk before you sign.

Can I change the clauses?

Yes. Download the Word version and edit it, or open the template in the nerix chat and ask for a clause that is stricter, shorter or in another language.

Templates

See all Company and legal templates

Templates

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