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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
___Written Warning (1
st
, 2
nd
, 3
rd
) ___ 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.)