Meetings Code of Conduct Complaint Form Order Number Identifying information from the person reporting the incident First Name: * Last Name: * Organization (affiliation): Are you the alleged victim? * Yes No Description of Alleged Violation Information about the person alleged to have committed misconduct First Name: * Last Name: * Date of alleged misconduct * Description of alleged misconduct: * Description of any supporting evidence and names of any corroborating witnesses Specific section(s) of SSA's code of conduct that allegedly were violated Description of attachments if any Conflicts of Interest Describe any relationships you may have with any parties, witnesses, or other individuals in a decision-making role for SSA that could reasonably lead to a real or perceived conflict of interest. By submitting this form, I certify that information I have provided is complete, true, and accurate to the best of my knowledge and belief.
