Whistleblowing Form - Southern Co-op

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This form may be used to raise concerns relating to wrong doing, risk or malpractice in respect of Southern Co-op’s activities that a colleague has witnessed in the workplace, or that have been evidenced by a member, customer, supplier or other stakeholder.

Examples of the types of matters, which it would be appropriate to report using this form are:

bribery or corruption, money laundering or terrorist financing
theft or fraud
financial irregularities
dangerous acts or omissions which create a risk to health, safety or the environment
instances of modern slavery
other criminal activities
failure to comply with any other legal obligation
Covering up a wrongdoing

Personal grievances should not be raised via this process. These should be raised as follows:

colleagues via the Southern Co-op Grievance Procedure
members/customers via Member Support and Customer Services team
business relationships via the complaints process set out in your contract.

Read our Whistleblowing Policy here.

Whistleblowing Report Form

If you would prefer to submit your form by post, please print, complete and send this form to the address below:

Society Secretary
Southern Co-op
1000 Lakeside, Western Road
Portsmouth
PO6 3FE

Your details

We encourage you to provide your personal details so that when investigating your concerns we are able to seek additional information from you if necessary, and are able to advise you of the outcome of our investigation at its conclusion. We understand, however, that some people may not be comfortable in providing their details. If this is the case please leave this section blank. We will still investigate your concerns so far as we are able to do so with the information you have provided, but regret that we will not be able to advise you of the outcome.

Name

Email

Phone Number

Sometimes, particularly if a concern is complex it can be easier for us to respond to your query by telephone. If you are happy for us to contact you in this way please leave your number.

If you do not answer, may we leave a voicemail?

YES

NO

Is there a best time of day to contact you?

(Monday to Friday)

Relationship to Southern Co-op(Required)

Your concern

Which part of Southern Co-op does this concern relate to:(Required)

Which branch, department or third party was involved?(Required)

If known, which people were involved?(Required)

If you do not know names of those involved can you describe them?

Where specifically did the incident take place?(Required)

Approximate date of incident, or date range if appropriate(Required)

Have you reported your concerns to anyone else, if so who and when?(Required)

Details of Your Concern(Required)

Please describe the incident in as much detail as you can.

How are you aware of the incident?(Required)

What action do you believe should be taken as a result of registering your concern?(Required)

Do you have any evidence of the concern you are raising?(Required)

YES

NO

Attach a file

Max. file size: 2 MB.

You can add supporting documents (Microsoft Word or pdf format) or standard format image files. Or you can send supporting documents to us by email to [email protected]. Important: If emailing please quote your unique reference number, which we will confirm when you submit your report if you provide your contact details.

Has anyone else witnessed the incident, if so who?(Required)

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Email

This field is for validation purposes and should be left unchanged.

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