Complaint of Reprisal Form

  • Does this apply to me?

    The Public Interest Disclosure (Whistleblower Protection) Act applies to employees of government departments, offices of the Legislature, MLAs and their offices, Minister’s and their offices, the Premier and the Premier’s office, and public entities as prescribed in the Act's Regulations. If you believe you have been reprised against as a result of reporting a wrongdoing, seeking advice about reporting a wrongdoing, refusing to participate in a wrongdoing or doing anything in accordance with the Act, you may complete the form below to make a complaint to the Public Interest Commissioner. If you are unsure about any section of this form please call 1-855-641-8659 or E-mail: info@pic.alberta.ca

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  • General Contact Information

  • Information about the Reprisal

  • Please provide a description of the reprisal(s) or threat(s) that have occurred or are occurring. Be sure to include all relevant dates, locations and names of individuals involved. Please attach any available supporting documents.

  • Declaration

  • Drop files here or
    Accepted file types: jpg, jpeg, png, doc, docx, txt, pdf.
    - Individual files are limited to 5 MB.
    - Maximum of 3 file uploads.
    - Retain your copy of files you submit.
    - Acceptable formats include: jpeg, png, doc, docx, txt, pdf.