Anonymous Complaint Form

Submit your concerns securely with our Anonymous Complaint Form. It's a discreet, easy-to-use platform that respects your privacy. Safely report issues without fear of repercussion. Your voice matters, and we're here to ensure it's heard.

3 minutes to complete

Eligibility

This form should be filled out by those individuals who agree to participate in the survey anonymously.

Questions for Anonymous Complaint Form

Questions for Anonymous Complaint Form

1.

What is the nature of your complaint?

The answer should be a multiple choice:
  1. Workplace behavior
  2. Harassment or discrimination
  3. Policy violation
  4. Safety concern
2.

When did the incident occur?

The answer should be a date input.
3.

Where did the incident take place?

The answer should be a text input.
4.

Who was involved in the incident?

The answer should be a text input.
5.

Please describe the issue in detail.

The answer should be a text input.
6.

Have you reported this issue to anyone else?

The answer should be a single choice:
  1. Yes, I have reported it to a supervisor.
  2. Yes, I have reported it to the customer support team.
  3. No, I have not reported it yet.
  4. No, I am planning to handle it myself.
7.

Do you have any evidence or supporting documents?

File needs to be uploaded.
8.

What action would you like to see taken to resolve this issue?

The answer should be a text input.
9.

Is there anything else you would like to add?

The answer should be a text input.
10.

Would you like to be contacted for follow-up?

The answer should be a single choice:
  1. No, I want to remain anonymous.

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What Is The Crime Or Incident You Would You Like To Tell Us About?

This form is to be used to report any incident or crime that you witnessed. Please provide as much detail as possible, including any relevant screenshots or other evidence.

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The information you submit is confidential. This form can be used to report a crime or in assisting police with ongoing unsolved cases.

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An Anonymous Complaint Form is a document that allows individuals to report misconduct, discrimination, harassment, or any other violation without revealing their identity.

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BlockSurvey is a privacy-focused platform for collecting data through forms, surveys, assessments, and quizzes. The data collection is end-to-end encrypted, and it ensures complete privacy of your audience from Big Tech. With an array of ready to use templates, it is tailored for the needs of businesses and individuals from Web 3, HR, Mental Health, Sexual Health, Activism and many sensitive areas where data collection needs protection.

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