Report of Illegal Or Unethical Conduct Form

Whistleblower Complaint

Report of Illegal or Unethical Conduct Form

This form is to be completed by any person who wishes to file a report alleging illegal or unethical conduct at the EPFL. The whistleblowing procedure allows EPFL to be informed as rapidly as possible of any serious irregularities that may occur. The reporting of any suspected serious irregularities is in the interests of EPFL and in keeping with good corporate governance practices.

The term serious irregularity is used to signify illegal or unethical conduct as defined under Articles 2 and 5, paragraph 2 of the Guidelines of the ETH Board for the handling of reports of illegal or unethical conduct observed by members of the ETH Domain of 4 July 2006, particularly activities involving corruption, safety violations, duress, sexual harassment, etc.

Irregularities are reported via a substantiating letter sent to the independent reporting authority designated by EPFL in accordance with Article 4, paragraph 2 of the above-mentioned Guidelines of the ETH Board. Any EPFL employee or student is entitled to report serious irregularities. If, owing to the nature of the facts, it is not possible to report these to the person’s immediate superior or another competent person, the report should be sent to the independent reporting authority. As a general rule, such reports must be signed by their authors although, in exceptional cases, they may be submitted anonymously.

For more information, see the “Guidelines of the ETH Board for the handling of reports of illegal or unethical conduct observed by members of the ETH” Domain of 4 July 2006, the EPFL “Directives concerning whistleblowing at EPFL” of 7 July 2008 and the EPFL “Directive concerning research integrity and good scientific practice at EPFL”.

How do You Wish to be Identified?

_____ Anonymous Source

_____ Confidential Source

_____ No Restriction

Name: ______Title: ______

Department: ______Location: ______

Mailing Address: ______

Telephone Number: Work ______Home______

Have you reported this matter to your supervisor, Human Resources, Audit, etc.? If so, who was contacted and what where the results? Please provide as much information as possible. Please attach additional pages as needed.

Subject Party (person or persons alleged to have performed an improper governmental activity)

Name: / Department: / Job Title:
Name: / Department: / Job Title:
Name: / Department: / Job Title:

Please provide a description of the incident(s) with as much detail as possible. Please include the nature of the improper activity; names of EPFL employee(s) and department(s) and approximate or actual date the activity took place. Please attach additional pages as needed.

Signature: ______Date: ______

Send the completed form marked "Confidential" and any attachments to:

Prof. Patrick Francioli

Commission cantonale d'éthique de la recherche sur l'être humain

Avenue de Chailly 23

CH-1012 Lausanne

Tél. +41 21 316 18 30/31

Email:

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