Submission - Public Interest Disclosure Form

Questions marked with an * are required. Disclosures under PIDA cannot be assessed without these completed fields.

1. *Indicate if the alleged wrongdoing is about:

    The Superintendent
    The Secretary Treasurer
    Both the Superintendent and the Secretary Treasurer
    Employee
    None of above

2. *Are you a member of the public, meaning never been employeed by the Vancouver School District?

Yes
No

5. *A report may be made under the Public Interest Disclosure Act for any of the following categories of wrongdoing. Please check one or any that apply:

    serious act or omission that, if proven, would constitute an offence under an enactment of British Columbia or Canada;
    an act or omission that creates a substantial and specific danger to the life, health or safety of persons, or to the environment, other than a danger that is inherent in the performance of an employee's duties or functions;
    a serious misuse of public funds or public assets;
    gross or systemic mismanagement;
    knowingly directing or counselling a person to commit a wrongdoing described above.

If your report does not fall within one of these categories, you may wish to consider whether your report falls under another policy or administrative procedure of the School District.

6. *While anonymous disclosures may be accepted under the Public Interest Disclosure Act, we may not be able to investigate if we are unable to contact you to confirm you are a current or former employee or to obtain further details, evidence, or clarification about your disclosure.

Do you wish to submit this Disclosure anonymously?

Yes
No

7. Please enter your contact information below so that we can communicate with you about your disclosure. Your identity and contact information may be shared with investigators to allow them to communicate with you.

First Name

Last Name

Street Address

Unit Number

City

Province

Postal Code

Daytime Phone Number

Other Phone Number

Email Address

How would you prefer to be contacted? May we leave a message for you?

8. *In the space below, please describe the alleged wrongdoing and the person(s) alleged to have committed the wrongdoing. Please provide as much detail as you are able, including:

A description of the wrongdoing and any relevant background,
The names of those responsible,
When and where the wrongdoing occurred,
Names of people who witnessed the wrongdoing, if available,
Any law or legislation that has been breached.

Please attach any relevant documents or other files related to the wrongdoing.

Accepted file types: .jpg, .jpeg, png, doc, docx, pdf, Max.files size: 5MB, Max.files: 3

Note: you don’t have to provide supporting materials

Attach files

9. Have you previously reported the wrongdoing to the School District?

Yes
No

10. Please describe any other steps or action that you or others have taken to address, report or prevent the reported wrongdoing.

11. Do you know of any other organizations that are investigating the reported wrongdoing or whether other complaints or claims about the wrongdoing have been filed (e.g. court filings, grievance, human rights complaint, privacy complaint, police investigation, etc.). Please explain.

Please review the data you have entered before submitting your Disclosure. Once submitted, it CANNOT be changed.

Disclosure Report