Disclosure of Wrongdoing Form

This Form is designed to assist you providing information to Red River College Polytechnic under Policy P2- Public Interest Disclosure Protection Policy. All disclosures must be in writing. Making the Disclosure by completing this Form accurately and in full will help the College assess, review and/or investigate the alleged wrongdoing in accordance with our Policy and the law.

If you are unable to include all the details about the alleged wrongdoing on this form, you may submit further details as a separate document. If you have questions please do not hesitate to contact

The College’s General Counsel
cjfrost@rrc.ca

The Designated Officer, Vice President Finance and Administration
lzapshalla-kelln@rrc.ca

Thank you for your submission. It has been received by the appropriate parties. If you provided a contact method, you will receive a reply within 10 working days.

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Your Contact Information

Please enter your contact information below. While anonymous disclosures may be accepted, they also may be more difficult to investigate or substantiate. Your identity will be protected to the fullest extent possible and reprisal protection for reporting in good faith will apply.

Type of Wrongdoing

The wrongdoing I wish to disclose relates to: (please check all that apply*)

an act or omission constituting an offence under an act of the legislature or the Parliament of Canada, or a regulation made under an act

an act or omission that creates a substantial and specific danger to life, health or safety of persons, or to the environment, other than a danger that is inherent in the performance of the duties or functions of an employee

gross mismanagement, including of public funds or a public asset

knowingly directing or counselling a person to commit one or more of the wrongdoings described above

*If none of the above options apply to your concern, the Public Interest Disclosure (Whistleblower Protection) Act does not apply. Please consider addressing the matter through other internal policies and procedures, or contact the College’s General Counsel at cjfrost@rrc.ca.

Disclosure Details

In the space below, please provide information about the wrongdoing and the person(s) alleged to have committed the wrongdoing. The following details are required, if known:

a description of the wrongdoing;
the names of those responsible;
when the wrongdoing occurred; and
has this matter has already been reported and, if so, what was the response

Disclosure of Wrongdoing Form

Your Contact Information

Type of Wrongdoing

The wrongdoing I wish to disclose relates to: (please check all that apply*)

Disclosure Details

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