Appendix 3-S: Sample Investigation Report Form

Investigation Report

Investigator: _________________________________

Case Number: _______________________________

Case Open Date: ______________________

Case Closure Date: ___________________

Allegations:

____ Substantiated

____ Partially Substantiated

____ Unsubstantiated

____ Insufficient Information – Unconclusive

I. Summary

A. Allegation Overview

On ______________________________, the Company received a complaint of ______________________________ via ______________________________.

The complaint alleged that:

1. ________________________________________________________________

__________________________________________________________________

2. ________________________________________________________________

__________________________________________________________________

3. ________________________________________________________________

__________________________________________________________________

B. Persons Involved

The following persons were alleged to have engaged in wrongdoing:

________________________________________________________

C. Investigation Process

The following individuals were interviewed as part of this investigation:

Name/Title/Date of Interview


Name/Title: Date: Length of Interview: Key Findings:	Name/Title: Date: Length of Interview: Key Findings:
Name/Title: Date: Length of Interview: Key Findings:	Name/Title: Date: Length of Interview: Key Findings:

The following documents were gathered and reviewed as part of this investigation:

________________________________________________________________