Whistleblower Disclosure

Section 1 of 520% complete

Section 1

About you

Choose whether you would like to remain anonymous and tell us about your relationship to CHC.

Would you like to remain anonymous? *

Please select an answer.

What is your name? *

Please enter your name.

Preferred contact details? *

Please provide a contact method.

Is there a safe or preferred way and time to contact you? *

Please tell us how and when it is safe to contact you.

What is your relationship to CHC? *

Please select your relationship to CHC.

Please specify your relationship to CHC *

Please enter your relationship to CHC.

What is the nature of your concern? *

Please select the nature of your concern.

Section 2

Details of your concern

Provide as much factual detail as you safely can.

Please describe what happened or what you believe may have happened *

Please describe what happened.

Who was involved? *

Please provide an answer.

When did it happen? *

Please select a date.

Where did it happen? *

Please provide a location.

Has it happened more than once? *

Please select an answer.

How did you become aware of the matter? *

Please select an answer.

Please specify how you became aware of the matter *

Please enter how you became aware of the matter.

Why do you believe the conduct may be improper or unlawful? *

Please provide an answer.

Section 3

Witnesses and supporting information

Tell us where relevant information may be found. Do not identify yourself if you wish to remain anonymous.

Are there any witnesses or other people who may have relevant information? *

Please select an answer.

Please provide their names or details, if known

Are there documents, photographs, records or other information that CHC could locate independently? *Do not identify yourself if you wish to remain anonymous.

Please provide an answer. You may enter “None” or “Unsure”.

Is there any other place CHC could obtain relevant evidence? *

Please provide an answer. You may enter “No” or “Unsure”.

Supporting files Optional — up to 5 files in this proof of concept.

PDF, Office documents, images or text files

Section 4

Safety and protection

Let us know if anyone may need immediate support or protection.

Are you concerned about your safety, wellbeing or possible retaliation because of this report? *

Please select an answer.

Please describe your concerns *

Please describe your concerns.

Is anyone else at risk of retaliation or harm? *

Please select an answer.

Is there any immediate action you believe CHC should consider to protect someone or preserve evidence?

Section 5

Previous reporting and acknowledgement

Complete the final details, then review the acknowledgement before submitting.

Have you previously reported this matter? *

Please select an answer.

Who did you report it to and when? *

Please provide the reporting details.

Is there anything else CHC should know?

Proof-of-concept notice: This private preview demonstrates the intended experience. It does not transmit or retain the report or attached files.

Acknowledgement * I understand that submitting false or misleading information may affect CHC’s ability to assess the matter.

Please acknowledge before submitting.

✓

Disclosure prepared

Thank you for speaking up

Keep this confidential reference number for your records.

This proof of concept has prepared your completed form locally. No information has been transmitted or stored.