Report Form: Allegations of Research Misconduct or Breaches of Research Integrity

This form is for making a complaint or allegation about a breach of research integrity or research misconduct. Before proceeding please read the Responsible Conduct of Research Procedure and consider discussing the matter with a Research Integrity Adviser (RIA).

This form is not for reporting matters of concern unrelated to the conduct of research itself, such as workplace bullying and harassment. There are separate University processes for dealing with these matters.

If sections are not applicable or you don’t know the information please clearly state this, please do not leave sections blank.

1. Details of person lodging the allegation

Title: *

Given Names: *

Surname *

Organisation: *

Position title: *

Organisation/Faculty: *

Please provide details if 'other' was selected *

Contact Number *

Postal Address *

Email *

1.2 Are you lodging the allegation in a personal or professional capacity? *

1.3 If you are a CDU staff member or student, please provide your University ID Number

2. Details of (Primary) Person alleged to have committed Research Misconduct. Please complete as much as you can.

If more than one person is involved in the same matter, please replicate the information for each individual and attach as a seperate document to this form.

Title *

Given Names *

Surname *

Organisation *

Position title: *

Organisation/Faculty: *

Please specify if "other" was selected

Contact Number *

Email *

2.1 At the time the alleged Research Misconduct occurred was the person/s involved staff or students of CDU? *

YesNo

3. Date/s the alleged Research Misconduct occurred. *

If more than one date, please specify all dates:

if 'other', please specify:

5. Clearly outline the type of misconduct or activity that is alleged to have occurred.

Declaration

I hereby declare that the information I have provided is true and correct to the best of my belief.

Signature *

Clear

Date *

Name *

Position *

Please upload any evidence that supports your allegation

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Once signed, press submit, this form will be sent confidentially to the Research Ethics and Integrity Officer via email to researchintegrity@cdu.edu.au. You will also receive a copy of the form and any attachments as a PDF.

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