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limited!to!grievances,!reprimands,!suspensions,!demotions,! pe rformance!ratings,!or!general!dissatisfaction! PLEASE!NOTE:!Improper!governmental!activities!cannot!be!related!to!personnel!matters,!including!but!not! (San Francisco Bay Area Rapid Transit District)

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The limited!to!grievances,!reprimands,!suspensions,!demotions,! pe rformance!ratings,!or!general!dissatisfaction! PLEASE!NOTE:!Improper!governmental!activities!cannot!be!related!to!personnel!matters,!incl form is 3 pages long and contains:

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BROWSE SAN FRANCISCO BAY AREA RAPID TRANSIT DISTRICT (CA) FORMS
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!
Fraud,!Waste,!or!Abuse!Complaint!Form!
BART’s'Office'of'the'Inspector'General'(OIG)'inves tig at e s'a lleg a tio n s'o f 'im p ro p e r'
governmental'activities'that'involve'fraud,'waste,'or'abuse'regarding'BART’s'programs'or'
operations,'including'cont rac te d 'a ct ivitie s .'Allegations'may'be'reported'by'BART'employees,'
contractors,'or'the'general'public.'Complainants'remain'anonymous'unless'they'give'written'
permission'for'their'names'to'be'revealed'or'if'release'of'their'nam e 'is'requ ired'to 'be'
provided'to'appropriate'law'enforcement'personnel'who'are'conducting'a'criminal'
investiga tio n .'P rio r'to 's u b m it tin g 'a'c o m p la in t,'p le as e 'visit'www.bart.gov/IG'to'determine'if'
your'allegation'meets'the'definition'of'fraud,'waste,'or'abuse'and'to'read'more'about'
whistleblower'protections.'
'
PLEASE!NOTE:!Improper!governmental!activities!cannot!be!related!to!personnel!matters,!including!but!not!
limited!to!grievances,!reprimands,!suspensions,!demotions,! pe rformance!ratings,!or!general!dissatisfaction!
with!management!decisions.!
'
Your!Information!
You'have'the'option'to'remain'anonymous,'but'our'inability'to'discuss'this'matter'directly'with'you'may'prevent'us'
from'investiga ting 'this'co m p lain t.'Please'click'this'box'if'you'wish'to'remain'anonymous:'☐'
First'Name:' ''Last'Name:' '
Department/Company'Name:' '
Title:' '
Phone:' ''Email:' '
How'did'you'hear'about'the'whistleblower'program?'
'
!
'
Subject(s)!Information!
*First'Name:' ''*Last'Name:' '
*Subject’s'Organization'(name,'department,'and'divisio n ,'if'k n own):'
'
Title:' '
Address' '
Phone:' ''Email:' '
Subject’s'Supervisor’s'Name:' '
Supervisor’s'Phone:' ''Supervisor’s'Email:' '
If!multiple!peo ple !a re !in v o lv e d ,!p le as e !e mail!information !fo r !th e !additional!subjects!to!
InspectorGe ne r al@bart.gov.!
'
Allegation'
Please'provide'a'detailed'description'of'the'improper'
activity,'including:'
• What'is'the'improper'activity'(state'a'specific'activity ,'
not'a'generic'one)?'
• How'did'you'become'aware'of'the'incident'(e.g.,'
personal'observation,'someone'else'told'me'they'saw'
or'heard'about'it)?'
• What'laws,'regulations,'policies,'rules,'or'terms'of'
contracts'or'grant'provisions'were'violated?'
• Where'did'the'improper'activity'o ccu r?'
• What'was/is'each'person’s'role'in'the'im pro pe r'
activity?'
• On'or'about'what'date'did'the'activity'first'occur?'
• Is'the'act ivit y's till'o n g o in g ?'
• If'quant ifia b le ,'w h a t'is 'th e 'es timated 'd o lla r'lo s s'o r'
potential'amount'for'recovery?'
• Are'any'supervisors'or'managers'aware'of'the'
improp e r'a ctiv ity ,'an d 'if's o ,'ha v e't h ey 'ta ken 'an y'step s'
to'stop'it?'
*Complaint:'
'
'
Specific'evidence'is'needed'to'support'allegations.'Please'
provide'a'list'of'available'evidence'to'corroborate'the'
allegation.'Evidence'can'include,'for'example:'
• Documents'such'as'emails,'invoices,'logs,'contra c ts ,'
vouchers,'spreadsheets,'memoranda,'letters,'
pictures,'reports,'min u te s /meeting'note s '
• A'vehicle'number'or'license'plate'number'
• Sample'materials'
'
For'each'piece'of'evidence'listed,'please'provide'the'
name(s)'and'contact'information'(phone'number'and'
email)'of'the'individual(s)'who'created'it.'
*Evidence:'
'
'
Other!Investigations!of!Allegation'
Has'this'issue'been'reported'to'or'investigated'by'BART 'or'an oth er'ag en cy,'or'ha ve 'you 'filed'a'law suit'or'grie van ce '
related'to'this'issue?'''Yes'☐'''No'☐'
*If'yes:'
Provide'the'organization'where'reported,'and'name,'title,'and'contact'information'of'the'person'respon sible 'for'
conducting'th e'inv estigatio n:'
'
*What'is'the'current'status'of'the'investigation:'In'Progress'☐''Complete'☐'
If'comp le te ,'p lea s e'd e s cr ib e't h e 'o u tc o m e 'o f't h e 'in ve st iga t io n '(e .g. ,'su b s ta n tia te d 'a n d 're a so n s,'not 'su bstanti a te d 'a n d '
reasons,'if'provide d:'
'
If!available,!please ! email!a!copy!of!the!final!report!to!Inspect o rG e n e r al@bart.gov.!!
'
Witness!Information!
Do'others'know'about'the'improper'activity,'and'if'so,'what'do'they'know?'Please'provide'information'abou t'each'
witness:'
'
First'Name:' ''Last'Name:' '
Witness’'Organization'(name,'department,'and'division,'if'known'and'applicable:'
'
Title:' '
Address' '
Phone:' ''Email:' '
Please'describe'the'witness’'relationship'to'the'subject'and'the'information'that'they'can'confirm:'
'
If!there!are!mu ltip le !witnesses,!please !e mail!the!addition al!witness!inform at io n !to !
InspectorGe ne r al@bart.gov.!
'
*☐'I'certify'that'this'disclosure'is'made'in'good'faith'and'that'all'statements'made'in'this'disclosure'are'true,'
complete,'and'accurate'to'the'best'of'my'knowledge'and'belief.'
'
Whistleblower!Protection!
Individuals'who'report'an'improper'activity'by'a'District'employee'or'contractor'doing'business'with'BART'
or'who'participate'in'an'investigation'of'suspected'ethics'violations'are'protected'from'retaliation'under'
California'Labor'Code'Section'1102.5'and'other'California'laws,'as'well'as'BART’s'Whistleblower'Policy.'
'
PLEASE!EMAIL!YOUR!COMPLETED!FORM!TO!
Inspecto rGenera l@bart.go v !
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limitedtogrievances,reprimands,suspensions,demotions, pe rformanceratings,orgeneraldissatisfaction PLEASENOTE:Impropergovernmentalactivitiescannotberelatedtopersonnelmatters,includingbutnot (San Francisco Bay Area Rapid Transit Di

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Completed 30 August 2020

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