State of Wisconsin Department of Administration Division of Personnel Management DOA-15807-A (R9/2020) § 230.34 & § 111.80, Wis. Stats.
EMPLOYEE INVESTIGATION REPORTS FIRST REPORT OF POTENTIAL WORK RULE VIOLATION
This form shall be utilized to document initial allegations of work rule violations and to initiate a formal investigation. The completed form must be submitted to Human Resources.
THIS SECTION TO BE COMPLETED BY SUPERVISOR OR HUMAN RESOURCES STAFF
SUBJECT OF INVESTIGATION (Last Name, First Name, M.I.) [Last Name, First Name, M.I.]	JOB TITLE OR CLASSIFICATION [Classification]	AGENCY / DIVISION / WORK UNIT
INCIDENT DATE(s): [Incident Date(s)]	INCIDENT TIME(s)	EMPLOYEE STATUS Permanent Probationary LTE
BRIEF DESCRIPTION OF INCIDENT(s) (who, what, where, when and why, if known) attach related documents.
WITNESSES AND/OR POTENTIAL WITNESSES
NAME OF PERSON REPORTING ALLEGATION	CLASSIFICATION	DATE OF REPORT
ADDITIONAL INFORMATION AND/OR EVIDENCE
THIS SECTION TO BE COMPLETED BY HUMAN RESOURCES STAFF
SPECIAL CONSIDERATIONS / ACTIONS IF NECESSARY	TEMPORARY REASSIGNMENT	ADMINISTRATIVE LEAVE WITH PAY	ADMINISTRATIVE LEAVE WITHOUT PAY	NO CHANGE
OTHER:
CONDUCT INVOLVES POSSIBLE CRIMINAL VIOLATION(S)
OTHER:
EMPL ID:	EXEMPT NON-EXEMPT	SENIORITY DATE:	CASE NUMBER (If applicable): [Case Number]
NAME(S) OF ASSIGNED INVESTIGATORS: