Whistleblower Complaint Form

Instructions: Complete the “Whistleblower Complaint Form” and click the “Submit” button at the bottom of this form

Employees and members of the community are encouraged to provide as much specific information as possible, including names, dates, places, the events that took place, and the reason(s) why the incident(s) may constitute a violation or misconduct.

While you may submit a complaint anonymously, we may not be able to determine whether your complaint has merit if we are not able to interview you.

When you click the “submit” button, your form will be sent to whistleblower@nvta.ca.gov Please note that the website will distribute your complaint form to the NVTA Board Chair, NVTA Vice-Chair, and NVTA Legal Counsel.

Are you a NVTA employee?
YesNo

If YES, what is your position or relationship to NVTA? (optional).

Identify the person or persons against whom your allegations are being made.

Describe the nature of your complaint, the incident(s) or event(s), date(s), time(s), place(s).

Identify others who may have observed or witnessed the above incident(s) or event(s).

If you have additional supporting documents, please list them here and email them to whistleblower@nvta.ca.gov, or attach them in the field below.

Supporting documents

If you would like your complaint to be distributed to other individuals on the NVTA Board or staff, please provide additional names and/or emails in the field below.