Purpose
Use this form to report the following incidents and grievances:
- Incidents: Injuries, near misses, safety/security concerns, data/privacy breaches, environmental issues, or service outages, etc.
- Grievances: Discrimination, harassment, bullying, retaliation, unfair treatment, wage/scheduling issues, disciplinary disputes, policy violations, ethics concerns, or quality of service, etc.
Submission Instructions
The primary preferred submission method is via jotform. Alternatively, download the necessary form on our website: https://www.health.gov.ck/incident-and-grievance-form/ and submit via email to tmo.helpdesk@cookislands.gov.ck or submit form physically to a Supervisor, Manager or Human Resources (HR).
Note: In the event of an emergency, contact emergency services immediately before submitting a report.
Confidentiality and Commitment
All information provided will be managed confidentially, adhering strictly to TMO policies and applicable regulation and legislation. Reporting an incident or grievance will not lead to discrimination or retaliation.
Ensure all sections are completed accurately and honestly to enable a fair and timely assessment.