Please provide additional information the person(s) alleged to be responsible for the reprisal(s). Name: Job title or Rank (RCMP): Federal Department / Organization: Work Telephone: Work Unit: Work Address: Name: Job or Rank (RCMP): Federal Department / Organization: Work Telephone: Work Unit: Work Address: For an action to be considered under the Act, the measure(s) you identified above must have been “reprisal” taken against you because you made a protected disclosure of wrongdoing or cooperated in a related investigation. A protected disclosure concerning a wrongdoing can be made to: your supervisor; or the designated Senior Officer appointed in your organization under the Public Servants Disclosure Protection Act; or the Public Sector Integrity Commissioner. A protected disclosure may also include wrongdoing allegations made: in the course of a Parliamentary proceeding; in the course of a procedure established under any other Act of Parliament; or when lawfully required to do so. Did you make a protected disclosure of wrongdoing or have you cooperated in an investigation? Yes No If yes, please provide details, including relevant and names of the people to whom or the office to which you made a protected disclosure. If you made a disclosure of wrongdoing to our Office, you only need to include the PSIC file number (i.e. D2016-0000):
Please provide additional information the person(s) alleged to be responsible for the reprisal(s). Name: Job title or Rank (RCMP): Federal Department / Organization: Work Telephone: Work Unit: Work Address: Name: Job or Rank (RCMP): Federal Department / Organization: Work Telephone: Work Unit: Work Address: For an action to be considered “reprisal” under the Act, the measure(s) you identified above must have been taken against you because you made a protected disclosure of wrongdoing or cooperated in a related investigation. A protected disclosure concerning a wrongdoing can be made to: your supervisor; or the designated Senior Officer appointed in your organization under the Public Servants Disclosure Protection Act; or the Public Sector Integrity Commissioner. A protected disclosure may also include wrongdoing allegations made: in the course of a Parliamentary proceeding; in the course of a procedure established under any other Act of Parliament; or when lawfully required to do so. Did you make a protected disclosure of wrongdoing or have you cooperated in an investigation? Yes No If yes, please provide details, including relevant and names of the people to whom or the office to which you made a protected disclosure. If you made a disclosure of wrongdoing to our Office, you only need to include the PSIC file number (i.e. D2016-0000):