Carroll County Government Fraud, Waste, or Abuse Reporting Form

Submit this form by email, mail, or in person to:

Email Address: fraud@carrollcountymd.gov Office Address: Timothy C. Burke Office of County Attorney 225 North Center Street Westminster, MD 21157 Phone Number: 410-386-5030 Policy - Reporting Improper Actions by Carroll County Government Employees, Contractors, or Agents Carroll County Government strongly encourages employees and other persons to report known or suspected improprieties including, but not limited to, instances of fraud, embezzlement, bribery, theft, abuses of authority, gross mismanagement, gross waste of funds or property, the making of false statements or false claims when such statements or claims are known to be false, the exposure of employees to a substantial and specific public health danger, or any violation of federal or state law that have been committed by any employee at any level of authority or by the Carroll County Government s agents or independent contractors. To the extent allowed by law, Carroll County Government will seek to maintain the confidentiality of such reports, including the identity of the employee or other person who makes the report and the identity of the employee, agent, or independent contractor who is the subject of the report. Carroll County Government will take steps to protect from retaliatory action any employee or other person who, in good faith, reports known or suspected improprieties

• Citizens may provide contact information or remain anonymous.
• Please provide as much detail as possible concerning who, when, where, what, how, and how much is involved.
• The information reported is reviewed by the County Attorney.

1. Please provide a detailed description of the incident, including who, what, where, why, when, and how.

2. Provide the name(s) of the person(s) involved, their role(s) in the incident, job title(s)and location(s) currently employed or enrolled

First Name

Last Name

Job Title

Role

Location

First Name

Last Name

Job Title

Role

Location

Name

Job TitleFirst NameLast Name

Role

Location

3. If applicable, enter any additional individuals involved.

4. What is your involvement in the incident?

Other

5. Where did the issue occur?

6. When did it occur or the date of the most recent occurrence?

Date

Is this an ongoing issue?

8. Have you reported this incident to anyone within Carroll County Government(CCG)?

9. If Yes, who did you report it to?

10. Please provide the date(s) the incident was reported to the CCG employee identified in question 9.

Date

11. Do you believe anyone has taken steps to hide this issue?

12. Do you have files to provide?

If yes, please mail the documents to: Carroll County Government Attention: Office of County Attorney 225 North Center Street Westminster MD 21157

Send Electronic files to fraud@carrollcountymd.gov

13. May we contact you?

Upon your request, all information is kept confidential to the extent allowed by law and will not be shared. If you do not wish to remain anonymous, please include your full name, address, phone, email, and any additional contact information.

Name

First NameLast Name

Address

City

State

Zip Code

Home Phone

Format: (000) 000-0000.

Work Phone

Format: (000) 000-0000.

Cell Phone

Format: (000) 000-0000.

Email Address

example@example.com

Contact Instructions