Identifying Information

Provide your contact details so we can reach out if further documentation is required.

Your Full Name *

Contact Number *

Email for Updates *

Workplace / Affiliation

Contact / Postal Address *

Who is this report about?

Identify the practitioner or entity the complaint concerns.

Respondent Type *Select…Individual PractitionerEngineering FirmOther Entity

Registration Number

Name of Practitioner / Entity Complained Against *

Nature of the Complaint

Select the category that best describes the alleged misconduct.

Nature of Complaint *

NegligenceDishonestyBreach of ContractConflict of InterestUnsafe PracticeMisrepresentationOther

Description of Alleged Misconduct *

A clear, factual account helps the Committee assess the complaint.

Supporting Information

Optional, but strengthens your complaint.

Witnesses

Steps Already Taken

Supporting Documents

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Up to 5 files — PDF, JPG, PNG or DOC.

Declaration

Confirm and sign to submit your complaint.

I declare that the information provided above is true to the best of my knowledge and belief. I understand that this complaint will be handled confidentially in accordance with the Whistleblower Act, 2006 (Act 720).

Signature *

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