1. DESCRIPTION OF THE ALLEGED ILLEGAL CONDUCT/IRREGULARITY

Corruption and maladministration, abuse of powerMismanagement of resources and damage to public financesIllegal procurementConflict of interestFailure to implement anti-corruption regulationsViolations of transparency regulationsother (provide a brief description of the unlawful conduct)

Indicate the time period in which the event occurred (period and, if possible, the date on which the events reported occurred)

Duration of the unlawful conduct The unlawful conduct has endedThe unlawful conduct is still ongoingThe unlawful conduct occurs repeatedly

Description of the facts
(clearly describe the unlawful conduct you wish to report and all the information necessary for its assessment)

How did you become aware of the incident?

Is there any administrative, civil or accounting litigation in relation to the reported facts? YesNoI don't know

Can you provide useful information to verify the accuracy of your report?
(If you provide detailed information and instructions to assist us in verifying the accuracy of the report, it will be quicker and easier for us to take action)

If you have already submitted other reports to the Company on the same facts, indicate the channels and the date.

2. ANY PERSONS INVOLVED
(Note: fill in a form for each person involved)

First name and surname

Administration, body or company for which or with which the person involved works
(indicate the body or company for which or with which the person indicated works)

Position held by the person involved in the administration or body to which they belong

Role played by the person involved in the incident

Telephone number

Email address or certified email address

Did they benefit financially or in any other way from the incident? YesNoI don't know

In your opinion, can we contact the person to request further information without compromising the confidentiality of the investigation? YesNoI don't know

3. ANY COMPANIES INVOLVED
(Note: fill in a form for each person involved)

Company name of the company involved

Registered office address

VAT number/Tax code

Legal representative or other person (director) of the company involved in the incident

Role of the company in the incident

Telephone number

Email address or certified email address

Website

4. ANY OTHER ENTITIES INFORMED
(Note: fill in one form for each entity receiving a report)

Which authority or institution have you already contacted? Court of AuditorsJudicial authorityPoliceCarabinieriFinance PolicePublic Service InspectorateOther police forces

Date of report

Details of the report (number and year of registration by the authority)

Outcome of the report

5. DOCUMENTARY EVIDENCE: Files attached to the report (maximum 5 .pdf files, or alternatively a single .zip file, each no larger than 2 MB)

Attachment
Attachment
Attachment
Attachment
Attachment

6. IDENTITY OF THE REPORTING PARTY

Type of reporting party (select one of the following options) Company employee or collaboratorEmployee or collaborator in a position of authorityEmployee or collaborator of companies supplying goods or services or companies carrying out work on behalf of the Company

First name and surname

Date of birth

Place of birth

Tax code

Address

Telephone number

Email address or certified email address (PEC)

Current place of work

Current job title and duties

Place of work at the time of the reported incident

Job title and duties at the time of the reported incident

6.1. If the reporting person is an employee or collaborator of companies that supply goods or services or companies that carry out work on behalf of the Company, please also complete the following section

Company name

Registered office address

VAT number/Tax code

Legal representative or other person representing the company

Telephone number

Email address or certified email address

Website

7. PRIOR AUTHORISATION

If, in the context of any disciplinary proceedings initiated by the Company against the alleged perpetrator of the reported conduct, your identity is essential to the defence of the accused, do you hereby authorise Casa di Cura Città di Rovigo Srl to transmit your data to the relevant offices?
YesNo

Note: if you answer no, in the above case, the disciplinary proceedings will have to be discontinued and no action can be taken against the alleged perpetrator of the reported conduct.