# Whistleblower Report Form, Free to Fill In Source: https://nerix.ai/templates/whistleblower-report-form Let someone raise a serious concern in writing, with room for evidence and a confidentiality choice. Before you send it 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. ## Fill it in and preview You are signed in. Fill it in your workspace and it is kept as a document you can send, share and have signed. [Open in your workspace](https://app.nerix.ai/documents/templates/whistleblower-report-form) ### 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](mailto: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](https://nerix.ai/templates/company-legal) 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 About you - 2 The concern - 3 Evidence - 4 Our promise - 5 For the organisation Templates ## How it works - 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. - 02 ### Check Read it through. Gaps you have not filled stay marked, so nothing goes out half done. - 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. [Adapt it with nerix](https://nerix.ai/try?template=whistleblower-report-form) ### Was this template helpful? 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 ## More in Company and legal - [Acceptable use policy Set clear rules for using your systems, accounts, devices and services, and what happens when they are broken. Company and legal](https://nerix.ai/templates/acceptable-use-policy) - [Agency agreement Appoint an agent to find customers and negotiate sales for you in an area, for a commission. 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