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Reprisal Complaint Form

Public Interest Disclosure Act

The Public Interest Disclosure Act empowers the Ombudsperson to investigate reprisal complaints from current and former employees of BC government ministries, Crown corporations, health authorities, public school districts and other public sector organizations listed here.

The information you provide in this form will be used to assess whether your complaint will be investigated. Please provide as much detail as possible. If you have questions about completing the form, please contact our office. You will immediately be put through to staff who can help.

Items with a star “*” next to them are required fields.

  • Contact Information
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  • Employment Information
  • 1. Are you a current or former employee of a public sector organization covered by PIDA?
  • 2. If yes, for which public sector organization?
  • 3. When did you work there?
  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • Description of the reprisal
  • 4. Was the reprisal related to*
  • Please provide details about the above activity.
  • a) Who did you communicate with?
  • b) What did you speak about?
  • c) When did you communicate?
  • d) How did you communicate?
  • 5. What measure(s) of reprisal were taken against you?
      Please check one or more of the following. *
  • 6. Please provide us with the following details:
  • a. Describe how your employment or working conditions were negatively impacted. *
  • b. Where did the reprisal(s) occur? (Organization and location) *
  • c. Who took the measure(s) of reprisal against you? Please provide their name(s) and title(s). *
  • d. When did the reprisal measure(s) take place? If more than one incident of reprisal has occurred, please indicate the date the incidents began and their frequency or duration. *
  • e. What information do you have that supports that you suffered adverse consequences at work BECAUSE you sought advice, made a report of wrongdoing, or cooperated with an investigation? *
  • If you have already reported it, please describe:
    • when you reported the reprisal
    • who you reported the reprisal to
    • the response you received and any ongoing proceedings
  • Evidence
  • 8. Please attach any documents, records, correspondence, recordings or other evidence that you have in your possession related to the reprisal complaint and any previous reports of the allegation you have made.
    You may upload up to 3 files Maximum file size limit is 5 MB Accepted file formats: pdf, doc, docx, txt, jpg, png Please retain the files that you upload for your own records
  • Drop files here or
    Accepted file types: jpg, jpeg, gif, png, doc, docx, txt, pdf, Max. file size: 5 MB, Max. files: 3.
    • Declaration
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