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 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, or refusing to participate in a wrongdoing, 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

 

  • * indicates a required field.

  • General Contact Information

  • While the Commissioner can accept anonymous complaints, you are encouraged to include your name and contact information. For more information about the advantages and disadvantages of making an anonymous complaint, contact our office.

  • Information about the Reprisal

  • Use this Text Area to describe in as much detail as possible, each of the following as applicable:

    The Original Disclosure

    Describe the original disclosure of wrongdoing you made or that gave rise to the act of reprisal you are writing about today. Include:

    • all relevant dates,
    • locations,
    • people or organizations involved,
    • attach any supporting documentation

    The Reprisal

    Describe the reprisal(s) or threat(s) that has or is occurring. Be sure to include:

    • all relevant facts including dates,
    • locations,
    • people or organizations involved,
    • why you reasonably believe a reprisal has been taken against you, and
    • attach any supporting documents.

    Other Information

    Include any additional information you wish to provide. Attach any 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.