{"id":12719,"date":"2025-08-04T04:12:24","date_gmt":"2025-08-04T04:12:24","guid":{"rendered":"https:\/\/www.fijiroads.org\/?page_id=12719"},"modified":"2025-08-04T04:12:24","modified_gmt":"2025-08-04T04:12:24","slug":"whistleblower-reporting-form","status":"publish","type":"page","link":"https:\/\/www.fijiroads.org\/index.php\/whistleblower-reporting-form\/","title":{"rendered":"WHISTLEBLOWER REPORTING FORM"},"content":{"rendered":"<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof 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field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >WHISTLEBLOWER&#039;S CONTACT INFORMATION [OPTIONAL]<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_1'>\n                            \n                            <span id='input_11_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_11_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                    <input type='text' name='input_1.3' id='input_11_1_3' value=''   aria-required='false'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_11_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_11_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                            <input type='text' name='input_1.6' id='input_11_1_6' value=''   aria-required='false'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_11_2\" class=\"gfield gfield--type-email gfield--input-type-email field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_2'>Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_2' id='input_11_2' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_11_4\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_4'>Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_4' id='input_11_4' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_11_9\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >DETAILS OF PARTIES INVOLVED IN THE DISCLOSURE<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_11_9'>\n                            \n                            <span id='input_11_9_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_11_9_3' class='gform-field-label gform-field-label--type-sub '>First Name<\/label>\n                                                    <input type='text' name='input_9.3' id='input_11_9_3' value=''   aria-required='true'     \/>\n                                                <\/span>\n                            \n                            <span id='input_11_9_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_11_9_6' class='gform-field-label gform-field-label--type-sub '>Last Name<\/label>\n                                                            <input type='text' name='input_9.6' id='input_11_9_6' value=''   aria-required='true'     \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_11_38\" class=\"gfield gfield--type-post_content gfield--input-type-post_content gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_38'>If more than one person is involved, please enter their names here.<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_38' id='input_11_38' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_11_8\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_8'>Relationship to the FRA (Employee, contractor etc.)<\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_11_8' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_11\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_11'>Title(s) (For Employees and Internal Stakeholders):<\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_11_11' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_12\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_12'>Division and Department(s) (For employees):<\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_11_12' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_13\" class=\"gfield gfield--type-post_custom_field gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_13'>Email(s), if available:<\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_11_13' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_11_14\" class=\"gfield gfield--type-post_custom_field gfield--input-type-number gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_14'>Phone Contact(s) if available:<\/label><div class='ginput_container ginput_container_number'><input name='input_14' id='input_11_14' type='number' step='any'   value='' class='large'      aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_11_16\" class=\"gfield gfield--type-multi_choice gfield--type-choice gfield--input-type-checkbox gfield--width-eleven-twelfths gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >TYPE OF COMPLAINT<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_11_16'><div class='gchoice gchoice_11_16_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.1' type='checkbox'  value='Dishonest Practices'  id='choice_11_16_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_16_1' id='label_11_16_1' class='gform-field-label gform-field-label--type-inline'>Dishonest Practices<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_16_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.2' type='checkbox'  value='Code of Conduct\/Illegal Conduct'  id='choice_11_16_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_16_2' id='label_11_16_2' class='gform-field-label gform-field-label--type-inline'>Code of Conduct\/Illegal Conduct<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_16_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.3' type='checkbox'  value='Unethical Behavior'  id='choice_11_16_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_16_3' id='label_11_16_3' class='gform-field-label gform-field-label--type-inline'>Unethical Behavior<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_16_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.4' type='checkbox'  value='Breach of Polices'  id='choice_11_16_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_16_4' id='label_11_16_4' class='gform-field-label gform-field-label--type-inline'>Breach of Polices<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_16_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.8' type='checkbox'  value='Offering or accepting bribe\/gifts'  id='choice_11_16_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_16_5' id='label_11_16_5' class='gform-field-label gform-field-label--type-inline'>Offering or accepting bribe\/gifts<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_16_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.7' type='checkbox'  value='Collusion'  id='choice_11_16_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_16_6' id='label_11_16_6' class='gform-field-label gform-field-label--type-inline'>Collusion<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_16_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.6' type='checkbox'  value='Leakage of Confidential Information'  id='choice_11_16_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_16_7' id='label_11_16_7' class='gform-field-label gform-field-label--type-inline'>Leakage of Confidential Information<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_16_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.5' type='checkbox'  value='Criminal Offences'  id='choice_11_16_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_16_8' id='label_11_16_8' class='gform-field-label gform-field-label--type-inline'>Criminal Offences<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_16_9'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.9' type='checkbox'  value='Misuse of FRA Assets'  id='choice_11_16_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_16_9' id='label_11_16_9' class='gform-field-label gform-field-label--type-inline'>Misuse of FRA Assets<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_16_11'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.11' type='checkbox'  value='Abuse of Office'  id='choice_11_16_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_16_11' id='label_11_16_11' class='gform-field-label gform-field-label--type-inline'>Abuse of Office<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_16_12'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.12' type='checkbox'  value='Not Declaring Conflict of Interest'  id='choice_11_16_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_16_12' id='label_11_16_12' class='gform-field-label gform-field-label--type-inline'>Not Declaring Conflict of Interest<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_16_13'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.13' type='checkbox'  value='Public Safety Risk'  id='choice_11_16_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_16_13' id='label_11_16_13' class='gform-field-label gform-field-label--type-inline'>Public Safety Risk<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_11_16_14'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_16.14' type='checkbox'  value='Others (Provide details)'  id='choice_11_16_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_11_16_14' id='label_11_16_14' class='gform-field-label gform-field-label--type-inline'>Others (Provide details)<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_11_17\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_17'>FULL DISCLOSURE OF COMPLAINT<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_17' id='input_11_17' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_11_35\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_35'>Evidences (Please provide an exhaustive list of evidences submitted)<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_35' id='input_11_35' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_11_21\" class=\"gfield gfield--type-post_image gfield--input-type-post_image field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Evidence 1<\/legend><div class='ginput_complex ginput_container ginput_container_post_image gform-grid-row'><span class='ginput_full gform-grid-col'><input name='input_21' id='input_11_21' type='file' class='large'   aria-invalid=\"false\" aria-describedby=\"extensions_message_11_21\" \/><span id='extensions_message_11_21' class='gfield_description gform_fileupload_rules'>Accepted file types: jpg, jpeg, png, gif.<\/span><\/span><\/div><\/fieldset><fieldset id=\"field_11_34\" class=\"gfield gfield--type-post_image gfield--input-type-post_image gfield--width-full field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Evidence 2<\/legend><div class='ginput_complex ginput_container ginput_container_post_image gform-grid-row'><span class='ginput_full gform-grid-col'><input name='input_34' id='input_11_34' type='file' class='large'   aria-invalid=\"false\" aria-describedby=\"extensions_message_11_34\" \/><span id='extensions_message_11_34' class='gfield_description gform_fileupload_rules'>Accepted file types: jpg, jpeg, png, gif.<\/span><\/span><\/div><\/fieldset><fieldset id=\"field_11_22\" class=\"gfield gfield--type-post_image gfield--input-type-post_image gfield--width-full field_sublabel_above gfield--no-description field_description_above hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Evidence 3<\/legend><div class='ginput_complex ginput_container ginput_container_post_image gform-grid-row'><span class='ginput_full gform-grid-col'><input name='input_22' id='input_11_22' type='file' class='large'   aria-invalid=\"false\" aria-describedby=\"extensions_message_11_22\" \/><span id='extensions_message_11_22' class='gfield_description gform_fileupload_rules'>Accepted file types: jpg, jpeg, png, gif.<\/span><\/span><\/div><\/fieldset><fieldset id=\"field_11_26\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consent<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_26.1' id='input_11_26_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_11_26_1' >I declare that the information provided in this form is true and accurate to the best of my knowledge. I am making this disclosure in good faith with the intent to report an improper conduct. I understand the potential consequences of submitting false or misleading information and confirm that I have not knowingly provided any false statements.<\/label><input type='hidden' name='input_26.2' value='I declare that the information provided in this form is true and accurate to the best of my knowledge. I am making this disclosure in good faith with the intent to report an improper conduct. I understand the potential consequences of submitting false or misleading information and confirm that I have not knowingly provided any false statements.' class='gform_hidden' \/><input type='hidden' name='input_26.3' value='3' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_11_31\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><p style=\"color: red;\"><b>IT IS A SERIOUS OFFENCE TO GIVE FALSE OR MISLEADING INFORMATION TO THE AUTHORITY.<\/b><\/p><\/div><div id=\"field_11_28\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_11_28'>Lodgment Date<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_28' id='input_11_28' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_11_28_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_11_28_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_11_28' class='gform_hidden' value='https:\/\/www.fijiroads.org\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><div id=\"field_11_30\" class=\"gfield gfield--type-html gfield--input-type-html gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><p><h2>Note:<\/h2>\n<ol>\n<li>All complaints received are governed by the FRA Whistle Blower Policy<\/li>\n<li>Incomplete forms will not be accepted\/investigated<\/li>\n<li>For any queries or clarifications, the complainant may contact the toll-free number 5750<\/li>\n<li>Completed forms to be sent to the following addresses:<\/li>\n<ul>\n<li>Email to <b>wbinfo@fijiroads.org<\/b><\/li>\n<li>Delivered to the Office of the CEO at Level 4, Fiji Development Bank Building, 360 Victoria Parade Suva.<\/li>\n<\/ul>\n<\/ol>\n<\/p><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_11' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_11' value='postback' \/>\n            <input type='hidden' class='gform_hidden' 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