Class

Madison Group Limited

Madison Insurance House, Upper Hill Close, Nairobi

1. Issue details

Details*

2. Involved parties

The person(s) named below are set to receive this report. If they are implicated in this incident, tick against their name(s) and describe how they are involved

Risk & Compliance Manager

Describe the nature of involvement

Human Resources Manager

Describe the nature of involvement

Who else was involved?

3. Location

Enter an address, location name or other relevant location details where the incident took place *

4. Date

Please indicate when the issue occurred

Date

Time

I will provide a general timeframe

Enter general timeframe (e.g last week) *

5. Upload file

Attach file

6. Your relationship to the organization

I am currently an employee

I am a former employee

Non employee (this includes contractor, student, supplier, partner, member, etc.)

What is your relationship to this organization? *

7. Tell Us about yourself (optional)

Share your name and contact information

Name*

Email*

Mobile*

Preferred Contact Method*

Remain completely anonymous