We are
committed to eliminating wrongful, unsafe and unethical conduct. It is never in
a company’s best interest to have managers or employees violate laws, policies,
safety or ethical standards. When properly used, this survey will allow us to
maintain a trusting work environment and avoid unnecessary claims. If you have
any comments regarding the use or improvement of this survey, please let us
know.
Thank
you. Please help us by the answering the following questions:
Do you understand that our company does not tolerate sexual harassment,
discrimination, safety violations and ethical misconduct?
_____________________________________________________________________________________
Do you understand your ability to complain about unfair conduct,
including anything related to harassment, discrimination, safety or ethics?
_____________________________________________________________________________________
Do you understand that you are required to report the violation of
company policies?
_____________________________________________________________________________________
Are you aware of, have you witnessed, or have you been a victim of, the
violation of any company policy, including those prohibiting discrimination,
safety violations or ethical misconduct?
_____________________________________________________________________________________
Have you reported any and all workplace injuries by completing an
Injury Report?
_____________________________________________________________________________________
Is there any personnel, compliance, ethics or safety issue you have a
question about or would like to discuss?
_____________________________________________________________________________________
I declare the above
to be true and correct.
Name:
____________________________ Date:
_____________________
Signature:
________________________ Please return this form to within two
working days.
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