Date Approved: October 23 2023
Before filling out this Public Interest Disclosure Form, please review the School District’s Public Interest Disclosure Policy and Procedures 6730. www.rupertschools.ca/----. Please also ensure that you provide all required details and attach copies of any documents you wish to submit as part of your report. The completed form (together with all attachments) may be submitted by mail or email to firstname.lastname@example.org or 634 6th Avenue East, Prince Rupert B.C. V8J 1X1.
The personal information submitted in this Public Interest Disclosure Form is collected by the School District under sections 26(a) and (c) of the Freedom of Information and Protection of Privacy Act, and will be used to assess, review, investigate and respond to allegations of wrongdoing made under the Public Interest Disclosure Act. If you have any questions about the collection, use or disclosure of your personal information in connection with your disclosure, please contact the District Privacy Officer at email@example.com, 634 6th Ave East or 250 624-6717.
Reports made under the Public Interest Disclosure Act are received and held in confidence by the School District. The reports and information received will be used and shared only to the extent reasonable and necessary to assess, investigate and respond to your disclosure and will not be used or disclosed for other purposes except as permitted or required under the Freedom of Information and Protection of Privacy Act and the Public Interest Disclosure Act or other applicable laws.
COMPLETING THE DISCLOSURE FORM
The purpose of this Public Interest Disclosure Form is to assist you in making a disclosure under the Public Interest Disclosure Act. The requested information is to ensure we have sufficient information to carefully review, investigate and respond to your disclosure. If you are unable to provide all requested details at the time you make your initial disclosure, you may ask to submit additional details at a later time.
☐ Yes ☐ No
☐ Yes ☐ No
While anonymous disclosures may be accepted under the Public Interest Disclosure Act, we may not be able to investigate if we are unable to contact you to confirm you are a current or former employee or to obtain further details, evidence or clarification about your disclosure.
e.g. How would you prefer to contacted? May we leave messages for you?
☐ serious act or omission that, if proven, would constitute an offence under an enactment of British Columbia or Canada;
☐ an act or omission that creates a substantial and specific danger to the life, health or safety of persons, or to the environment, other than a danger that is inherent in the performance of an employee's duties or functions;
☐ a serious misuse of public funds or public assets;
☐ gross or systemic mismanagement;
☐ knowingly directing or counselling a person to commit a wrongdoing described above.
If your report does not fall within one of these categories, you may wish to consider whether your report falls under another policy or procedure of the School District. www.rupertschools.ca
DESCRIPTION OF ALLEGED WRONGDOING
☐ Yes ☐ No
If yes, please indicate who the report was made to and any actions taken.
REPORT DATE AND PERSON REPORTED TO
OTHER ACTION TAKEN