Whistleblowing Complaint Form – FOCOS Orthopedic Hospital

REPORTER’S CONTACT INFORMATION (Optional)

First Name

Position

Address

Email address

Home Address

Last Name

Employer/Unit

Work Phone

Home Phone

Best Time/Place To Reach You

SUSPECT(S) INFORMATION (Required)

First Name*

Position*

Address

Home Address

Last Name*

Department/Unit*

Work Phone*

Home Phone

WITNESS(ES) Please provide witnesses that can confirm your allegation

First Name*

Title*

Department/Unit*

Home Phone

Last Name*

Work Phone*

Allegation Number(s)

COMPLAINT: (Briefly describe the 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, use as many pages as necessary).*

UPLOAD SUPPORTING DOCUMENTS / OPTIONAL

UPLOAD DOCUMENTS

Maximum size 5MB

UPLOAD PHOTOS

Maximum size 1MB

Are you human?*

This field should be left blank

Evidence Notice

Please describe how a FOCOS investigator could locate supporting documentation or attach a copy of evidence that you have already in your possession. You should NOT ATTEMPT TO OBTAIN evidence for which you do not have a right of access, as such, whistleblowers are “reporting parties” not investigators.

Contact Information

Tel: (+233) 059-692-0909

Email: info@focosgh.com

8 Teshie Street, Pantang, Accra. Get directions

If you wish to make an appointment with a doctor, it is best that you visit the Appointment Booking Page directly.