Whistleblower Reportable Activity Form

The following is to be used to file a Reportable Activity as identified in the Canadian Diabetes Association’s Whistleblower Policy only.

If you have a concern of a more general nature, please click here for more information.

The Whistleblower Policy is intended to encourage employees and others to raise serious ethical or legal concerns within the Association. The Association will not permit any employees or volunteers to harass, retaliate or discriminate against those other employees, volunteers and stakeholders (the Complainant) who, in good faith, report a Reportable Activity. Retaliation in any form will not be tolerated. Any complainant who feels he/she has been subject to retaliation should report her/his concerns to either the Executive Director HR or the CFO and VP Organizational Excellence & Shared Services.

A complainant may remain anonymous. However, in order to allow for a better investigation of a complaint, the complainant should consider identifying themselves by giving their name, their telephone number and other contact information. Even if such contact information is not provided, the substance of the complaint will be treated with utmost confidence and not discussed with others except to the minimum extent necessary to conduct a complete and fair investigation. In all cases, the person who is alleged to have committed the infraction will be made aware of the complaint at an appropriate point during the investigation.

Your name (optional – you may submit your complaint
anonymously and/or online via the Association’s website):

Region/Operation/Department (optional):

Supervisor (optional):

Telephone (optional):

E-mail (optional):

The Canadian Diabetes Association will treat all reports made under this policy as confidential to the fullest extend that is consistent with conducting a full and fair investigation. Even if you make a report under this policy and disclose your identity. The Association will exercise care to keep confidential your identity until a formal investigation is launched. At that point, your identity will be disclosed to other individuals only to the extend necessary to conduct a complete and fair investigation.

Describe Reportable Activity: *

Date you became aware of Reportable Activity: *


Reportable Activity is: *

Region/Operation/Department suspected of Reportable Activity: *

Individual(s) suspected of Reportable Activity: *

How did you become aware of the Reportable Activity? *

Describe steps, if any, you took prior to completing this Report Form (e.g., informed supervisor) *

Please enter the word you see in the image: *



* mandatory fields