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This site is not a substitute to report an emergency. This site must not be used to report an emergency matter involving an imminent threat to life or property. Reports submitted through this site may not receive an immediate response. If your issue involved an immediate threat, contact the appropriate local authorities.
I understand this is not an emergency service.
 
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Fields marked with * are required.
What is your relationship to the company?

  
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If "Other", please explain:
 
Please enter the organization code or department associated with this concern.  If you do not know, enter: Unknown

  
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For internal use only:
 
To investigate your report properly, it is important that BPA knows the location of the concern. Please let us know the following information about the BPA location you are reporting about:

  


 
 

 
Information Regarding Date of Incident:

  
When did the incident occur?     *    

   
 
Has this been an ongoing occurrence?     *    

 
How long has the incident been occurring?
 
Start Date:

   
 
End Date:

   
 
Are you reporting about any specific individuals?

  
    *    

 
First Name, MI, Last Name:
 
First Name, MI, Last Name:
 
First Name, MI, Last Name:
 
First Name, MI, Last Name:
 
First Name, MI, Last Name:
 
Are there any witnesses or is there anyone else who is willing to contact or speak with BPA?

  
    *    

 
First, MI, Last Name
 
Contact Info:
 
First, MI, Last Name
 
Contact Info:
 
First, MI, Last Name
 
Contact Info:
 
Now I'd like you to describe your concern. Take as much time as you need and please be as detailed as possible.

  
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Why do you feel it is important that BPA investigate this matter?

  
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Is there a way for BPA to verify any of this information?

  


 

(IF YES, CIC SHOULD SAY) Please Explain:


 
Are there any specific documents that are relevant to your concern?

  
    *    

 
(IF YES, CIC SHOULD SAY) Describe these documents:
 
Describe these documents :
If you are willing to share the documents with BPA, you have the choice of emailing, faxing or using traditional mail. Please make sure your UCC (case number from this report) is clearly marked on any email or documents you send.
1.Email Option: info@getintouch.com (remember to include UCC in email)
2. Fax (domestic): 800-232-9236 (remember to include UCC on any fax) or (international) +001-612-926-4140 (remember to include UCC on any fax)
3. Mail: InTouch, 3101 Irving Ave S, Minneapolis, MN 55408 (remember to include UCC on any documents)

 
Have you reported, or tried to report, this concern through other Corporate channels?

  
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When did you communicate it?

   
 
What is the name of the person it went to?  (First Name, MI, Last Name)
 
What is that person's position?
 
What department is that person with?
 
What did you say?
 

What was the response?


 
Do you have any concern about being retaliated against for having made this call/report?

  
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(IF YES, CIC SHOULD SAY)  Please explain your concerns:
 
With respect to the concern you are reporting, what do you feel should be done and by whom?

  

 
Is there any additional information that you'd like to provide that would assist BPA in understanding your concern or in taking appropriate action?

  

 
Would you like to provide your name and contact information? While identifying yourself is optional, please be aware that if you remain anonymous, the information you provide in this questionnaire may be the only information available to the Company when addressing your concern, which may limit the Company's ability to evaluate and do a thorough investigation of your concern.                                 

  
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Name (First, MI, Last)
 
Employee ID:
 
Telephone Number:
 
Home/Work Address:
 
Email Address:
 
Preferred Contact Time:
 
Do you have anything else you would like to add or do you have any questions?

  

 
Thank you for your submission to the BPA Hotline.  Please be assured that BPA takes these reports seriously.  A review of the matter will be conducted based on the information you provided and if substantiated, appropriate action will be taken.  Please continue to check back for updates to your report.  Be sure to have your report number and password when checking for updates.

Was Security contact made? CIC NOTE: Refer to Emergency Protocol for reasons to call Security.

  


 
Name of Security Personnel:
 
Notes:
 

Please attach here any documents, videos, etc.