Whistleblower Complaint Report of Scientific Misconduct Form

Whistleblower Complaint Report of Scientific Misconduct Form Whistleblower Complaint Report of Scientific Misconduct Form

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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: Monday, May 04, 2009

Please provide a description of the incident(s) with as much detail as possible. Please include the nature of the improper scientific 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: ______________________________ Monday, May 04, 2009

Have you reported this matter to your supervisor, Human Resources, Audit, etc.? If so, who was<br />

contacted and what where the results? Please provide as much information as possible. Please<br />

attach additional pages as needed.<br />

Subject Party (person or persons alleged to have performed an improper governmental activity)<br />

Name: Department: Job Title:<br />

Name: Department: Job Title:<br />

Name: Department: Job Title:<br />

Monday, May 04, 2009

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