Confidential Disclosure Tool


The purpose of this form is to collect information on your perceptions of things that are wrong in VHA that may represent an ethical or legal concern to the Department of Veterans Affairs. You may also use this tool to report concerns with service delivery that may affect Veterans satisfaction. This survey is anonymous and all repots would be reviewed, evaluated and the information on the steps taken to address the issue will be housed in VA Pulse. Please provide reports about your experiences over the past six months only.

Responses are confidential and data will remain anonymous. Responses cannot be linked to individuals. All disclosures are voluntary and the anonymity of the submitter will be preserved. However, during the course of the investigation when specific details and names are provided, these may be referenced during the investigation and this may compromise the submitter anonymity especially in small teams. For these reasons, we recommend you carefully evaluate the information provided before submitting the form.

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