Whistleblower Report Form

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Reporter's Contact Information
LocationHead OfficeRFBI Armidale Masonic VillageRFBI Basin View Masonic VillageRFBI Bathurst Masonic VillageRFBI Bellingen Masonic VillageRFBI Benhome Masonic VillageRFBI Berry Masonic VillageRFBI Cessnock Masonic VillageRFBI Coffs Harbour Masonic VillageRFBI Concord Community VillageRFBI Dubbo Masonic VillageRFBI Glen Innes Masonic VillageRFBI Goulburn Masonic VillageRFBI Hawkins Masonic VillageRFBI Holt Masonic VillageRFBI Kurri Kurri Masonic VillageRFBI Lake Haven Masonic VillageRFBI Lakemba Masonic VillageRFBI Leeton Masonic VillageRFBI Moonbi Masonic VillageRFBI Raleigh Urunga Masonic VillageRFBI Tamworth Masonic VillageRFBI West Wyalong Masonic Village

Witness Information (if any)
LocationHead OfficeRFBI Armidale Masonic VillageRFBI Basin View Masonic VillageRFBI Bathurst Masonic VillageRFBI Bellingen Masonic VillageRFBI Benhome Masonic VillageRFBI Berry Masonic VillageRFBI Cessnock Masonic VillageRFBI Coffs Harbour Masonic VillageRFBI Concord Community VillageRFBI Dubbo Masonic VillageRFBI Glen Innes Masonic VillageRFBI Goulburn Masonic VillageRFBI Hawkins Masonic VillageRFBI Holt Masonic VillageRFBI Kurri Kurri Masonic VillageRFBI Lake Haven Masonic VillageRFBI Lakemba Masonic VillageRFBI Leeton Masonic VillageRFBI Moonbi Masonic VillageRFBI Raleigh Urunga Masonic VillageRFBI Tamworth Masonic VillageRFBI West Wyalong Masonic Village

Details of your complaint: Briefly describe the misconduct / improper activity and how you know about it. Specify what, who, when, where and how. If there is more than one allegation, number each allegation and use as many pages as necessary.

1. What misconduct / improper activity occurred?
2. Who committed the misconduct / improper activity?
3. When did it happen and when did you become aware of it?
4. Where did it happen?
5. Is there any evidence that you could provide us?
6. Please provide details of all parties involved.
7. Do you have any other details or information which would assist us in the investigation?
8. Any other comments that may assist with this investigation? Please attach any photos or supporting information (if relevant)