Fraud and Corruption Incident Reporting

Required fields are marked with an asterisk (*).

1. Are you reporting a fraud or a corruption incident? *

   • Fraud
   • corruption
   • fraud and corruption
   • unsure
2. Can we contact you about this referral? *

   • Yes
   • No
3. Name of person reporting fraud or corrupt conduct incident
4. Email address
5. Phone number
6. Mobile phone number
7. Postal address
8. Name(s) of person(s) that may have committed the alleged or suspected fraud or corrupt conduct *
9. How are they connected to DWATSIPM? *

   • Employee
   • supplier
   • contractor
   • volunteer
   • other (also include business area in DWATSIPM, if known)
10. Other *
11. Name of the company or agency where the suspected person(s) work for *
12. Date when the incident happened or occurred *
13. Date when you became aware of the incident *
14. Amount of money involved in the fraud * If not sure, please write down ‘Unsure’.
15. Describe the events and situation that lead to the fraud and/or corruption. *
16. Do you have any supporting documentation (including photos and/or video) that may assist us in an investigation? *

    • Yes
    • No
17. Other relevant information that you would like to provide

18. Collection Notice

    The Department of Women, Aboriginal and Torres Strait Islander Partnerships and Multiculturalism (DWATSIPM) is collecting your personal information through this form to receive, assess, investigate and manage reports of suspected fraud and/or corruption. This collection is undertaken in accordance with the Information Privacy Act 2009 (Qld) (IP Act) and the Queensland Privacy Principles. Where reasonable and practicable, reports may be made anonymously.

    Your personal information will be accessed by authorised officers and used or disclosed only for the purpose of managing your report, including, where required or authorised by law, disclosure to relevant integrity, oversight, investigative or law enforcement agencies, including the Crime and Corruption Commission. If insufficient information is provided, the department may be unable to fully assess, investigate or respond to your report.

    The department takes reasonable steps to protect your personal information. Information about how DWATSIPM manages personal information, including how to access or correct your personal information or make a privacy complaint, is available in the department’s QPP Privacy Policy (PDF).

    Consent *

    By providing your personal information (including any sensitive information) as part of your allegation, you (please check each box if agreed to):

    • consent to DWATSIPM’s collection, use and disclosure of your personal information in accordance with the QPP Privacy Policy and IP Act, including to other parties located overseas; and
    • acknowledge and agree that DWATSIPM will not be responsible under the IP Act for how the overseas party handles your personal information.