Chesterfield County, VA

Fraud, Waste & Abuse Reporting Form

Submit Fraud Complaints
Complete this form if you wish to submit a complaint online to the Fraud, Waste and Abuse Hotline Program. It is important that you provide detailed information regarding the nature of the allegations. Anyone submitting an anonymous allegation is asked to call the confidential / anonymous hotline 804-318-8000 within 2 weeks of the initial report so investigators have the opportunity to clarify or obtain additional information if needed. Without sufficient information, an investigation may not be possible.
Complete this form if you wish to submit a complaint online to the Fraud, Waste and Abuse Hotline Program. It is important that you provide detailed information regarding the nature of the allegations. Anyone submitting an anonymous allegation is asked to call the confidential / anonymous hotline 804-318-8000 within 2 weeks of the initial report so investigators have the opportunity to clarify or obtain additional information if needed. Without sufficient information, an investigation may not be possible.
Date & Time of Incident
Date & Time of Incident
Date & Time of Incident
Location of Incident
Details of the Incident
Who, What, Where, How, How Often, Etc.
Suspected Person(s) Involved
Names, Department, Division and Contact Numbers, if Known
Names & Contact Information for Others Involved or Having Knowledge of Incident
Vendors, County or School Employees, Etc.
Please Describe Any Evidence You Have
Documents, Photographs, Correspondence, Etc. Also Include Relevant ID Numbers such as Vehicle Tag Number, Car Make / Model, and Equipment Number.
How Did You Become Aware of the Incident?
Witnessed First Hand, Work Where Acts Occurred, Told by Others with First-Hand Knowledge, Etc.
How Did You Become Aware of the Hotline?
Contact Information
If you wish to remain anonymous, you may skip this section; however, we encourage you to share this information in case we need to contact you for further information.
Your Name
Your Phone Number
Your Email Address
If You Work for the County or Schools, Please Provide Your Department & Title