Whistleblower Complaint Form

Please provide us with your contact information, which will greatly assist our effort to properly handle your matter. If you choose not to provide this information, it may limit our ability to act upon your complaint. If you request confidentiality, we will make every effort to keep your identity confidential consistent with applicable Cuyahoga County, State of Ohio and federal laws, rules and regulations, and the provisions of our privacy policy. Our office does accept anonymous complaints.

* Required Field

I am requesting confidentiality

Yes

Your Contact Information

First Name

Last Name

Home Address

City

State

Zip Code

Home Phone Number

Cell Phone Number

Your Job Information

Your Employer

Business Phone

Your Concern

* Name(s) and title(s) of person(s) you are complaining about

* Brief description of complaint

Additional Information

Supporting Documentation

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