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EPSS CORRUPTION AND GRIEVANCES’ COMPLAINT FORM
EPSS Corruption and Grievances’ Complaint Form
Before you complete this form 1. Understand cases what we can and cannot investigate. 2. Be clear on what you are reporting and provide as much information as possible to enable further consideration by the Ethiopian Pharmaceuticals Supply Service. 3. Understand the protections that Ethiopian government apply to persons making complaints. This form is secured to protect your privacy and more details on alternative ways to contact us are available here. Email; mulusew.ayalneh@epsa.gov.et, melesse85@gmail.com Mobile; +251- 943516001 In person; Office of Ethiopian Pharmaceuticals Agency Ethics Liaison Directorate Fields with an asterisk * are mandatory fields.
1.your name? (Optional)
2. your telephone number? Optional
3 your email address? (Optional)
4 Is there another way that we can contact you?*
Yes
No
5. If your response for the above no. 4 is yes, how can we do that?
6. Have you previously reported this matter to the Ethiopian Federal Ethics and Anti-Corruption Commission?
*
Yes
No
7. Have you previously reported this matter to another Organisation?
*
Yes
No
8. What official/s and/or anybody or bodies are you making a report about?
Suppliers or Manufacturers
Staff member of a Member of the EPSS
Health facilities
If other, mention?
9. When did the suspected corrupt conduct occur?
*
If you don't know an exact time or date, please provide an approximate (for example, January 2013). If the conduct happened more than once, then please list the approximate timeframes.
10. Where did the suspected corrupt conduct occur?
*
(Include as much detail as possible. Where known, include the address and any other location-specific information that will assist the Commission in understanding where the conduct occurred.)
11. What is the name of the person/s, department and/or organization/s you are making a complaint about?*
*
(Include as much detail as possible, including (where known) a person’s first name and surname, the name of the organization that they work for, and the position or role that they hold within an organization.)
12. Describe the corrupt conduct that you suspect has occurred or is occurring?
*
(Include as many details as possible, including any actual or potential impacts that you believe are associated with the suspected corrupt conduct and, where known, the names of any persons that you believe may have witnessed or have knowledge of the suspected corrupt conduct.)
13. Do you have any other information you wish to provide?
*
(Include any other information that you think will assist the Agency is assessing the suspected corrupt conduct.)
14. Secure file upload
Drop files here or
Accepted file types: jpg, gif, png, pdf, docx.
If you wish to upload documents relevant to your complaint (e.g. Word documents, photos, or other supporting information), please do so below. Please note that the total size for all files uploaded cannot exceed 60mb.
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