Home Whistle-blower Form Whistle-blower Form Whistle-blower Form Indicates required field Contact Information Information message Your contact information Name First Name Last Name Email Phone Home Mailing Address Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code Other Information Are you a... Current Employee of a State Agency or a State Agency's contractor? Former Employee of a State Agency or a State Agency's contractor? Applicant for a position with a State Agency or a State Agency's contractor? None of the above. If one of the above, which Agency? - Select -Division of Administrative Hearings (DOAH)Agency for Health Care Administration (AHCA)Department of Agriculture and Consumer Services (DACS)Department of Business and Professional Regulation (DBPR)*Capital Collateral Regional Counsels (CCRC)Department of Citrus (Citrus)Florida Department of Corrections (FDC)Department of Children and Families (DCF)*Department of Commerce (DOC)* (Formerly DEO)Department of Education (DOE)Department of Elder Affairs (DOEA)Department of Environmental Protection (DEP)*Department of Financial Services - CFO (DFS)*Office of Financial Regulation (OFR)*Office of Insurance Regulation (OIR)*Florida Guardian Ad Litem Program (GAL)Florida State University Office of Audit and Advisory ServicesDepartment of Health (DOH)Florida Highway Safety and Motor Vehicles (FLHSMV)*Justice Administrative Commission (JAC)Department of Juvenile Justice (DJJ)Florida Department of Law Enforcement (FDLE)Office of Attorney General (OAG)Department of Lottery (DOL)Department of Military Affairs (DMA)Department of Management Services (DMS)*Office of Internal Audit University of Florida (UF)*Office of the Governor (EOG)Florida Commission on Offender Review (COR)Agency for Persons with Disabilities (APD)*Public Service Commission (PSC)Department of Revenue (DOR)Department of State (DOS)Florida CourtsFlorida Department of Transportation (FDOT)*Department of Veterans' Affairs (DVA)Board of Governors (BOG)Citizens Property Insurance Corporation (CPIC)Division of Emergency Management (DEM)Florida Housing Finance Corporation (FHFC)Florida Fish and Wildlife Conservation Commission (FWC)Florida Gaming Control Commission (FGCC)Office of Criminal Conflict and Civil Regional Counsel (OCCRC)None of the Above * Indicates that this agency's Office of Inspector General will accept this Whistle-blow Complaint directly. Information message Information about the Employee, Individual or Provider who is the subject of this complaint Name of the subject of complaint Position Title First Last Phone Address of the subject of complaint Address Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon ZIP/Postal Code When did the alleged violation or suspected violation occur? (mm/dd/yyyy) Information message Select the Office, Circuit/Region and County in which the person(s) are employed. If you are not sure of the correct location, select "I Don't Know" or "County Unknown" from the list. Office/Program - Select -I Don't KnowAdult ServicesChild CareDevelopmental DisabilitiesDomestic ViolenceEconomic Self-SufficiencyFamily SafetyFinancial ManagementHomelessness ProgramGeneral ServicesInformation SystemsInspector GeneralMental HealthRefugee ServicesSubstance Abuse Circuit/Region - Select -I Don't Know Circuit 1Circuit 2Circuit 3Circuit 4Circuit 5Circuit 6Circuit 7Circuit 8Circuit 9Circuit 10Circuit 11Circuit 12Circuit 13Circuit 14Circuit 15Circuit 16Circuit 17Circuit 18Circuit 19Circuit 20Northwest RegionNortheast RegionSuncoast RegionCentral RegionSoutheast RegionSouthern RegionHeadquarters County - Select -County Unknown AlachuaBakerBayBradfordBrevardBrowardCalhounCharlotteCitrusClayCollierColumbiaDeSotoDixieDuvalEscambiaFlaglerFranklinGadsdenGilchristGladesGulfHamiltonHardeeHendryHernandoHighlandsHillsboroughHolmesIndian RiverJacksonJeffersonLafayetteLakeLeeLeonLevyLibertyMadisonManateeMarionMartinMiami-DadeMonroeNassauOkaloosaOkeechobeeOrangeOsceolaPalm BeachPascoPinellasPolkPutnamSanta RosaSarasotaSeminoleSt. JohnsSt. LucieSumterSuwanneeTaylorUnionVolusiaWakullaWaltonWashington Information message Complaint Details - Provide as much information as you can Have you reported the alleged incident to any of the below or are you reporting this now for the first time? A supervisory official in writing The Chief Inspector General in the Executive Office of the Governor The Chief Inspector General's staff via the Whistle-blower's Hotline An Agency Inspector General or staff member (orally or in writing) The Florida Commission on Human Relations (orally or in writing) Reporting this now for the first time Suspected Violation (select all that apply) Falsified official records Created false or fictitious client files Wrongful use of position, employees, or equipment for personal gain Wrongdoing by management Retaliation against an employee Revealed confidential information Improper use of public money Contract fraud Did not follow laws, rules or policies when making a contract or purchase In contracts or making purchases the employee takes bribes, makes illegal bids, receives awards or fails to monitor a contract, has a conflict of interest or disobeys a rule Other… If other, provide short description. You may explain more in detail in the next area below. Warning message When submitting a complaint, please be as specific as possible. Give the name(s) of the DCF employee(s) or service provider who committed a wrongdoing such as falsification of records, fraud, waste, or mismanagement of State personnel, equipment, or monies. State exactly what happened. Provide witness' names and how to contact the individual(s), if known. Do you know the location of any records or documents to support your complaint? If so, please provide details of what they are and where they are located. Complaint Details Status message Your complaint will be reviewed and assessed upon receipt and someone in either the Agency Office of Inspector General or the Office of the Chief Inspector General will advise you in writing of whether your complaint meets statutory requirements to be designated as a whistle-blower complaint. A determination will also be made whether the complaint warrants investigation by the Inspector General, or whether a referral to another entity (such an management) is more appropriate. The more specific information that you provide, the better we are able to assist you. By selecting "Yes" I am acknowledging that my complaint and any other preliminary information available alleging a possible prohibited or retaliatory personnel action against me may be forwarded to the Florida Commission on Human Relations, without redaction, pursuant to Section 112.31895(1)(b), Florida Statutes. Selecting "No" may prevent the Office of the Chief Inspector General from forwarding my complaint and any other preliminary information alleging possible workplace retaliation against me to the Florida Commission on Human Relations for investigative purposes Yes No Please select who you would like to send this information to: My agency's Office of Inspector General Office of the Chief Inspector General Leave this field blank