HomeMy WebLinkAbout2024 Whistleblower Intake Form - WebCase #: 24- Received by:
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County of Hawaiʻi
Office of the County Auditor
Whistleblower Intake Form
Date: Time Received: Time Ended:
IMPORTANT NOTICE: COMPLETE AND ACCURATE INFORMATION REQUIRED
To ensure proper evaluation and potential investigation of your report, please provide thorough and
accurate details. Incomplete or vague submissions may result in the matter not being pursued. Include
all relevant facts, dates, names, and supporting information to assist in the assessment process.
Please note: Investigations are limited to employees, or entities that receive funds from the County of
Hawai‘i, and will only address allegations of fraud, waste, or abuse directly attributable to the use or
transaction of county funds.
REPORTER/CLAIMANTʻS CONTACT INFORMATION (Optional/Confidential Details)
Name: Phone Number:
Position/Department: Email Address:
*Please note, investigation activities is made more difficult if complaints are filed anonymously because of the
difficulty in obtaining evidence to corroborate the alleged improper activity before we begin an investigation.
SUSPECTʻS INFORMATION
Name: Phone Number:
Department/Agency: Position:
COMPLAINT INFORMATION Please use additional pages as necessary.
Describe the possible fraud, waste, or abuse:
1. What wrongdoing occured?
2. Who did the wrongdoing?
3. When did this occur (Please provide dates of the incidents)?
4. Where did this happen?
5. What enabled this to happen?
Evidence: Please describe how an OCA auditor could locate supporting documentation or attach a copy of evidence
that you have already in your possession. You should not attempt to obtain evidence for which you do not have a
right of access, as such, whistleblowers are “reporting parties,” not investigators.
Case #: 24- Received by:
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ADDITIONAL WITNESS INFORMATION
Name: Phone Number:
Department: Email:
Name: Phone Number:
Department: Email:
Name: Phone Number:
Department: Email:
COMPLAINT INFORMATION (Cont’d.)