Code of Conduct Form

Code of Conduct Form

First Name*

Last Name*

Member Number

AIHA Member Classification*

Select

Phone*

Email*

Person Complaint Levied Against*

Anonymous?*

Do you wish to remain anonymous during the course of any investigation? AIHA cannot guarantee that you will remain anonymous throughout the course of the investigation; however, we will do our best to protect your anonymity. In some cases, we will need to disclose your identity but we will make you aware of this before doing so.

Yes

Date of Event*

Approximate Date of the Event prompting this complaint.

Time of Event*

Approximate Time of the Event prompting this complaint.

Details*

Full details explaining the incident prompting this complaint.

Physically Threatened or Harassed?*

Did complainant feel physically threatened or harassed by person(s) involved prompting this complaint? Any physical threats or physical (or attempted) assaults should be immediately reported to local law enforcement.

Yes

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