Fraud Reporting Form

Audit Services Division

Allegation of Fraud, Waste or Abuse

Online Reporting Form

 

Alleged Incident

Please describe in as much detail as possible the alleged incident of fraud, waste or abuse. Please include times, locations, vehicles or equipment (telephone, computer, cash register, etc.) used and any possible witnesses.

Incident Date: This is a required field
 
Description of Incident: This is a required field

 

Subject
The subject is a County (please check)
Employee: Elected Official:

Vendor/Contractor:

Client*:

Other:

Unknown:

*Client refers to a person who receives a benefit from a County-administered program.

 

 

First Name: Last Name:
Department/Business Name:   Subject’s Phone Number: Subject’s Address:
 

 

Complainant
I wish to remain Anonymous:

Note: You can remain anonymous. Your name is not required to report an allegation of fraud, waste or abuse.

First Name: Last Name:  
 
Telephone Number: Address: Email Address:
 

How did you become aware of this information?

Add Attachments:

 

 

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