Whistleblower Form Cancer Council Queensland is committed to operating legally, properly and ethically and will protect and respect the rights of Whistleblowers.This form is the Whistleblower Form for the purpose of making a Misconduct Disclosure to Cancer Council Queensland pursuant to the Cancer Council Queensland Whistleblower Guideline and Procedure. Please refer to those documents for definitions and further information including how to determine whether you are a “Whistleblower” and whether your intended disclosure is a “Misconduct Disclosure”. In contemplating the use of this form please consider whether your concerns relate to a work-related grievance and may be more appropriately raised under Cancer Council Queensland’s Workplace Policy or Grievance Guideline.Eligible Whistleblowers are eligible for protections when they make Protected Disclosures under the Corporations Act. If you are an Eligible Whistleblower making a Protected Disclosure, we will not reveal your identity or the contents of your report to others unless you consent to us doing so or we are required or authorised by law to do so.The online form takes about 10-15 minutes to complete and you must complete it in one session. You can’t save the form.You can upload attachments to support your disclosure. The maximum size of an attachment is 10MB.If a Misconduct Disclosure is trivial, or unfounded allegations are made maliciously or when they are known to be false this may be viewed seriously, and the Whistleblower may be subject to disciplinary action.Once you submit your report, a confirmation screen will display your Reference Number. If you supplied your email address, we will send you a confirmation email including a PDF copy of your report and your Reference Number. The report will then be sent automatically to Cancer Council Queensland’s Whistleblower Officer (the Chief Financial Officer). If the CFO’s name is included as an involved individual at question 1 then the report will instead be sent to the General Manager, People (Employment and Volunteering), the Chief Executive Officer or the Chair of the Board (as appropriate depending on whether any of those individuals are involved).A Cancer Council Queensland representative will contact you to discuss your report as soon as reasonably practicable after submission.If the Human Rights Act 2019 (Qld) applies to a service that you have received from us (i.e. certain services that CCQ provides pursuant to contracts with the Queensland government) and your report relates to a Serious Breach of your human rights, please let us know and we will respond within 45 business days. If you are not satisfied with our response after this time, you can complain to the Queensland Human Rights Commission (see www.qhrc.qld.gov.au).Whistleblower FormAre you an Eligible Whistleblower (e.g. a CCQ employee, volunteer or supplier or person related to one these)? Your answer to this question won’t preclude you from lodging this disclosure but may have legal implications.* Yes No If known, please give details of the individual(s) involved in the suspected Misconduct Disclosure. First and last name or job title at Cancer Council Queensland. To ensure that this message is not sent to involved people, please indiciate which (if any) staff roles are included in your concern.Select any roles of individuals involved* Chief Financial Officer (CFO) Human Resource Manager Chief Executive Office (CEO) None of the above InvolvedRoles RequiredRoles RequiredRoles Please only select the involved role(s) OR None of the above. Have you contacted anyone else in relation to your concerns? Yes No Please provide details of when and to whom the concerns were reported. Please provide details of when and to whom the concerns were reported. Please provide details relating to the Misconduct Disclosure. Provide as much detail as possible.* What happened, when did it occur, where did it occur, what type of misconduct, how did you become aware of the misconduct? Do you have any other supporting evidence? Yes No Please describe and/or upload below. Upload file Browse FilesDrag and drop files hereChoose a fileCancelof Are you aware of any other supporting evidence not described or attached above? Yes No Please describe the nature and whereabouts of any further evidence below, if known. Are there any other individuals or organisations involved other than Cancer Council Queensland and/or the individual(s) named above? Yes No Please provide details below. Please provide any other details or information which would assist us in the investigation. Please describe any concerns you have regarding Detriment (e.g. discrimination or intimidation) that you or any other person may suffer (or have already suffered) because of this report. (Please note that Eligible Whistleblowers who make Protected Disclosures are entitled to protections. Please see the Cancer Council Queensland’s Whistleblower Guideline for more information.) Your DetailsYou do not have to provide a response to this question. Alternatively, you may respond with an alias and provide CCQ with an email address or phone number that does not identify you. However, anonymous disclosures may affect the ability for the misconduct to be investigated fully and for you to receive appropriate protection and support. As such, it is recommended that you provide enough information to allow for two-way communication so that we can ask follow-up questions or provide feedback. Please see the Cancer Council Queensland’s Whistleblower Guideline and Whistleblower Procedure for more information about anonymous disclosures.Any personal information that you supply is collected by Cancer Council Queensland (ACN 009 784 356) (“Cancer Council”, “we”, “us” or “our”) [www.cancerqld.org.au] so that we may take appropriate actions and contact you in relation to your Misconduct Disclosure. We may provide your information to third parties where required by law or so that such third parties may provide us with services in connection with our investigation of the Misconduct Disclosure. Please refer to our Privacy Policy for further details. By providing your information to us you consent to your information being disclosed or used for this purpose. We will take reasonable steps to ensure that such third parties deal with your information appropriately and only for the purposes relating to the investigation of the Misconduct Disclosure. Our Privacy Policy explains how you can contact us to access and correct your personal information or make a privacy complaint. Name First Name Last Name Phone Number Please enter a valid Australian phone number. Email example@example.com Address Street Address Street Address Line 2 Suburb State Post Code Preferred contact method Phone Email Post What is your connection to CCQ? (e.g. employee, volunteer, supplier, supporter, service user) SubmitShould be Empty:
