Helpline - Incident Management

We are committed to maintaining a culture of integrity and accountability. This form is for employees, contractors, vendors, or any third party to report known or suspected violations of laws, regulations, company policies, or our Code of Conduct.

You may submit this report anonymously. While providing your contact information allows us to follow up for clarification or additional details, we respect and protect anonymity if you choose not to identify yourself.


Non-Retaliation Assurance:

We strictly prohibit retaliation against anyone who, in good faith, raises a concern or participates in an investigation. Your report will be handled with care, professionalism, and confidentiality to the extent possible.


Instructions:

Please fill out all starred fields to the best of your ability, be as detailed as possible and ensure you click submit at the bottom of the form. Your report will be reviewed and responded to in a timely manner.

Tell Us About Yourself

Relationship to Organization*
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If you are a customer seeking assistance with one of our solutions or have general customer support inquiries, please contact support@surescripts.com or call 1 (866) 797-3239.


Please do not submit this form

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If you selected to be anonymous, this information will not be shared with anyone internal to Surescripts and will remain anonymous. This email is only to be used by the system to request/share updated information.

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This information will not be shared with anyone outside of Corporate Compliance

Would you like to Hide your email from Surescripts internal employees?
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Preferred Method of Contact

Tell us about the Issue

If at a company location, please describe the location below (address or building information.)


If unknown or not at a company location, please explain with as much detail as possible.

Do you know when this issue occurred? *

Please indicate the time of day the issue occurred

Please provide any details that would help us identify when this issue may have occurred.

Select all that apply

Please give a detailed description of the chain of events, outcomes, and what occurred.


You may include details about individuals in this field.

Tell us more about the issue

(names, roles, or describe if unknown)

(names, roles, or describe if unknown)

Have you reported this issue before?*
Is this an ongoing issue?*
Does this pose a threat to health, safety, or data security?*

I affirm that the information provided is accurate to the best of my knowledge.

I understand that retaliation for making a good faith report is strictly prohibited.


Please check below if you acknowledge:

Please update any photos or information that is related to this issue.

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