Make a report – Pelindo Bersih

Publish to client
- yes
Report ID
user_role
Which channel was used by the whistleblower?
- Telephone / Fax
- Email
- SMS / WhatsApp
- Mail
How would you like to be in the report?*
- I do not request Confidentiality and Anonymity.
- I wish my identity to remain Confidential.
I do not request Confidentiality and Anonymity.
I am able to be contacted for additional information and I do not place any restrictions on the release of my contact information.
I wish my identity to remain Confidential.
I am able to be contacted for additional information, but my name is kept confidential and is not shared.
I wish to remain Anonymous.
I choose to remain anonymous and it is not necessary for me to fill out the contact information. It is important to note that unless you provide us with another contact detail/email, we would not be able to contact you if we need additional information about your complaint.
Login_check_hidden
Do you want to create an account?
- Yes, I wish to create an account with the data below
- No, i do not wish to create an account
Creating an account allows you to track the status of all your reports as well as provide additional information and communicate with us.
Username*
Full Name*
Email*

If you create an account, this email will be used to login and for further communication.
Full Name*
Full Name
Email*

Report will be send to your email here.
Employee Number
Phone*
Address
Street Address City State / Province / Region ZIP / Postal Code
ID Number
How may we contact you?
- Telephone
- Email
- Interview in person
- Other
Multiple choice allowed.
Please specify:

4. When and where did the case occur?
Date Province City District
5. Since when has the case been occurring?
6. Has the case happened before?
- Yes
- No
- I don't know
When and where did the case occur?
Date Province City District

7. Is your information first or second hand?
- First Hand
- Second Hand
If the information is second hand, please state the name of the source:
Title Name Division / Position
8. Which department do you want to report?
9. Who are the people involved or engaged in the incident?
Title Name Division / Position
10. Any supervisor or management involved?
- Yes
- No
- I don't know
Please elaborate:
11. Have you ever reported this case to a supervisor, management, or other people?
- Yes
- No
If yes who?
Title Name Division / Position When?
12. Other than you, who is aware about the case?
- Only me
- Other(s)
Who else?
Title Name Division / Position
13. Are there witnesses in the case?
- Yes
- No
- I don't know
Title Name Division / Position

14. Is there anyone attempting to conceal the case and how?
15. If possible, please provide the amount of money and/or the quantity of goods or property related to the case?
16. Do you have anything to add related to the case?
17. Do you have evidence related to the case?
- Yes
- No
Please explain
18. Would you like to upload some files?
Drop files here or

Accepted file types: jpg, jpeg, png, gif, pdf, docx, xlsx, mp3, mp4, rar, zip, rar, doc, xls, txt, mkv, avi.
evidences such as documents, videos and photos, etc

Please review your report before sending:
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Discussion thread
Assign Department
[hidden] selected department
Note
day
Month
Year

Please review your report before sending: