"Internal Investigation Report Template"

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Internal Investigation Report Template
Draft or Final Report
Date: _______
Matter # ______
Category: ___________
Business Name /Location: ______________
Investigator(s): __________________________
Was the allegation or concern Substantiated? Y/N
Is it significant:
(If yes, indicate if any of the following have been notified)
__ Chief Ethics & Compliance Officer
___ Chief Legal Counsel
__ Chief Financial Officer
___ Chief Executive Officer
__ Internal Audit
___ Board of Directors
__ Others: (including local, state and federal authorities. Describe below.)
Identify disciplinary actions taken:
___None
___ Verbal Warning
st
nd
rd
___Written Warning (1
, 2
, 3
)
___ Suspension w/without pay
___ Deduction of Bonus
___ Termination
___Deduction of Bonus
___Other (describe)
Describe any corrective actions taken:
___None
___Policy Revision
___Education/Training
___Other (Briefly Describe)
Other known actions taken by reporter, complainant or accused:
___ Lawsuit
___Union Action (Briefly Explain)
___ Other (Briefly Describe)
___Government Agency (e.g. EEOC, Dept of Labor, State HR Commissions, Govt. Hotlines)
Investigation Summary:
(Briefly describe the actions taken in conducting the investigation.)
(Please list the name(s) of the individual(s) who were involved in the investigation. If an outside source
involved, please note.)
Internal Investigation Report Template
Draft or Final Report
Date: _______
Matter # ______
Category: ___________
Business Name /Location: ______________
Investigator(s): __________________________
Was the allegation or concern Substantiated? Y/N
Is it significant:
(If yes, indicate if any of the following have been notified)
__ Chief Ethics & Compliance Officer
___ Chief Legal Counsel
__ Chief Financial Officer
___ Chief Executive Officer
__ Internal Audit
___ Board of Directors
__ Others: (including local, state and federal authorities. Describe below.)
Identify disciplinary actions taken:
___None
___ Verbal Warning
st
nd
rd
___Written Warning (1
, 2
, 3
)
___ Suspension w/without pay
___ Deduction of Bonus
___ Termination
___Deduction of Bonus
___Other (describe)
Describe any corrective actions taken:
___None
___Policy Revision
___Education/Training
___Other (Briefly Describe)
Other known actions taken by reporter, complainant or accused:
___ Lawsuit
___Union Action (Briefly Explain)
___ Other (Briefly Describe)
___Government Agency (e.g. EEOC, Dept of Labor, State HR Commissions, Govt. Hotlines)
Investigation Summary:
(Briefly describe the actions taken in conducting the investigation.)
(Please list the name(s) of the individual(s) who were involved in the investigation. If an outside source
involved, please note.)
Internal Investigation Report Template
Who was Interviewed?
(Describe who was interviewed during the investigation include full name and title along with date of
interview.)
If matter involves/reports alleged issues with an employee, has employee been named in prior
reports over the past year? Y/N
If yes, please provide summarize prior incidents noting if matter reports same issue with employee.
This investigation was conducted to answer the following (describe the allegation or concern
reported):
Summarize the Investigation Findings:
Conclusion:
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