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Share a Concern: Drug or Alcohol Matter

  • This form is for employees of companies, organizations, or agencies that subscribe to AlignHR's Share a Concern service.

    If you are uncertain if your company, organization, or agency has an active subscription, please complete the company contact information and we'll verify that before replying to you.

    Information provided on this form is confidential and is used to contact AlignHR, LLC designated advisors only.

  • To what company, organization, or agency does this report apply? : *

  • Position: *

  • Please Describe Your Problem: *

  • Are There Any Witnesses? : *

  • Who else would have knowledge of this matter? (Please include witnesses here):

  • Why are you reporting this issue?: *

  • Has this issue occurred in the past? : *

  • If so, who did you report it to within the company? :

  • May we contact you? : *

  • What is the best way to contact you? : *

  • Please Provide Your Contact Information: *

  • What is the best day and time to contact you? (Please provide more than one time): *

  • You may attach any files, pictures, etc., that you feel applicable by dragging and dropping them here:
    (Acceptable Formats: .pdf, .png, .jpg, .jpeg)

  • By checking here, you agree to the following. This is required to submit this form.: *

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