Fillable Fwaform TTU Internal Audit Fraud Report Form

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Fwaform TTU Internal Audit Fraud Report Form

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TTU Internal Audit Fraud Report Form
Please complete, print, and mail to Internal Audit, Campus Box 5154, Cookeville, TN 38505.
See the following for more information on Fraud, Waste, and Abuse:
TTU Fraud, Waste, or Abuse Brochure
TTU Reporting Fraud, Waste, or Abuse Document
The nature of your concern:
Theft or misappropriation of funds
Forgery, false certifications, alteration of documents
Kickbacks, bribes, extortion
Improper or wasteful activity
Authorization or receipt of compensation for hours not worked
Environmental violations
Conflict of interest/ethics violations
Other
Detailed Description
Please provide a detailed description of the situation you wish to report.
Print Form
What University Department(s) is/are involved:________________________________
What University employees, students, or others are involved:
Employee(s)_____________________________________________________________
Student(s)_______________________________________________________________
Other(s) ________________________________________________________________
Relationship(s) ___________________________________________________________
When did this occur – date or time period? ____________________________________
How did you become aware of this problem?
Have you reported this to anyone else? Yes No
If yes, who ________________________________ and when ________________
Who else should we contact that would have relevant information?
Name _________________________________________________
Contact Information ______________________________________
Name _________________________________________________
Contact Information ______________________________________
Name _________________________________________________
Contact Information ______________________________________
Your Information
If you wish to remain anonymous, you do not have to provide contact information. However, we
encourage you to provide your contact information for any follow-up questions that may arise during
our review or to obtain a copy of the final report at the completion of the review. All contact
information provided is considered confidential under TCA 8-50-116. However, if you provide contact
information, and TTU has a separate legal obligation to investigate the complaint (e.g., complaints of
illegal harassment or discrimination), TTU cannot guarantee anonymity or complete confidentiality.
Name _____________________________________________________
Address ___________________________________________________
Phone _____________________________________________________
Email _____________________________________________________
Please complete, print, and mail to Internal Audit, Campus Box 5154, Cookeville, TN 38505.
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Fwaform TTU Internal Audit Fraud Report Form

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Completed 1 March 2020

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