Welcome to the Asset Protection Incident/Case Management System.

This section should be utilized by Senior Management or Asset Protection associates only.

If you are not AP, or a senior manager, and you need to report questionable activity, then click here.

Information captured using this form will be routed to the Investigative team for review and the necessary next steps. Please note you may be contacted to provide further information or conduct follow-up inquiries.

Items marked with a diamond ♦ are required fields.

Logged by (You, the person entering this report)

 
(By checking this box you agree to allow EthicsPoint to store your information in a “Cookie” on this computer.)
Your Name &
Contact Information
 
Prefix
(Select One)
♦
First Name
 
M.I.
♦
Last Name

♦
Job Title
♦
Associate ID
 

 
Phone Number (Preferred)

Please include the area code, extension,
and/or dialing codes if applicable.
 
Personal/Business Email
(Format: username@domain.com)
   

Reported by (The person who brought this incident to the company's attention)

Reporter
♦
Was this incident raised by another individual?
(Select One)
Reporter Name &
Contact Information
♦
Relationship to Conn's
(Select One)
♦
“Other” Relationship

 
Prefix
(Select One)
♦
First Name
 
M.I.
♦
Last Name

♦
Job Title
 
Associate ID
 

 
Phone Number (Preferred)

Please include the area code, extension,
and/or dialing codes if applicable.
 
Personal/Business Email
(Format: username@domain.com)
   

Incident Location & Address

Location
Select the incident location by clicking on the “Look Up” button below
~
Store ID
 
~
Location
 

~
Street/Mailing Address
 

~
City
 
~
St./Province
 
~
Zip/Post Code
 
~
Country
 
   

Issue Selection

Additional Issue(s)
*
Additional issues added to this form will be for used reporting purposes only and do not impact the questions or information requested. If there is any significant, important, or vital information regarding "Issue Two" or "Issue Three", please provide that information in the "Details" section of the report on the following page.

Incident Details

Date
♦
Do you know the exact incident date?
(Select One)
♦
Date of Incident

(Format: mm/dd/yyyy)
 
Time of Incident
(Select One of Each)
 
Approximate Date/Time of Incident

 

♦
Date Reported to Management

(Format: mm/dd/yyyy)
Transaction
♦
Is this incident associated with a transaction/invoice?
(Select One)
♦
Location #
(Store #)
 
Register #
 
 
Invoice #
 
♦
Date of Transaction

(Format: mm/dd/yyyy)
Source
♦
Source
(Select One)
♦
Describe “Other”.
 
Details
♦
Please provide all details regarding the alleged violation, including the locations of witnesses and any other information that could be valuable in the evaluation and ultimate resolution of this situation.
(Please take your time and provide as much detail as possible, but exercise care to not provide details that may reveal your identity unless you wish to do so. It may be important to know if you are the only person aware of this situation.)
   

Suspects

Suspects
♦
Were there any suspects in this case?
(Select One)
 
♦
Using the input controls below, create a list of suspects.
(At least one supsect is required)

 
  • Relationship to Conn's
  • Last Name▼
  • First Name
1.
  • Raymond
  • Bodnar
  • 18125149
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******


Relationship to Conn's

 
Relationship to Conn's
****
 
“Other” Relationship
****
 
Associate ID
480965666
 
Job Title
 

Name & Contact Information

 
Prefix
Mr.
 
First Name
Raymond
 
M.I.
M
 
Last Name
Bodnar
 
Address
****

 
City
****
 
St./Prv.
TX
 
Zip/Pst. Code
****
 
Country
****
 
Phone Number (Preferred)
****
 
Email
****

Additional Details

 
Details
****

Relationship to Conn's

♦
Relationship to Conn's
(Select One)
 
“Other” Relationship
 
 
Associate ID
(Max: 10 Numeric Digits Only)
X
Job Title
(Ex: Associate, Supervisor, Trainer)

Name & Contact Information

 
Prefix
(Select One)
♦
First Name
 
 
M.I.
 
♦
Last Name
 

 
Address
 
City
 
St./Prv.
 
Zip/Pst. Code
 
Country
 
Phone Number (Preferred)
Please include the area code, extension,
and/or dialing codes if applicable.
 
Personal/Business Email
(Format: username@domain.com)

Additional Details

 
Details
 
 
Examples:
• Build (overweight, slim, muscular, etc.)
• Marks (tattoos, scars, birth marks, etc.)
• Facial hair (moustache, sideburns, etc.)
• Attire & accessories

Additional Participants (Witnesses, Victims, Accomplices, & Other)

Non-Suspects
♦
Were there any additional participants that were not suspects?
(Select One)
 
♦
Using the input controls below, create a list of additional participants.
(At least one participant is required)

 
  • Relationship to Conn's
  • Role
  • Last Name▼
  • First Name
1.
  • Raymond
  • Bodnar
  • 18125149
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******


Role & Relationship

 
Role in Incident
****
 
“Other” Role
****

 
Relationship to Conn's
****
 
“Other” Relationship
****
 
Associate ID
480965666
 
Job Title
Sr. Programmer
 
Supervisor
Sr. Programmer

Name & Contact Information

 
Prefix
Mr.
 
First Name
Raymond
 
M.I.
M
 
Last Name
Bodnar
 
Address
****

 
City
****
 
St./Prv.
TX
 
Zip/Pst. Code
****
 
Country
****
 
Phone Number (Preferred)
****
 
Personal/Business Email
****

Additional Details

 
Details
****

Role & Relationship

♦
Role in Incident
(Select One)
X
“Other” Role
 

♦
Relationship to Conn's
(Select One)
 
“Other” Relationship
 
X
Associate ID
(Max: 10 Numeric Digits Only)
X
Job Title
(Ex: Associate, Supervisor, Trainer)
 
Supervisor
 

Name & Contact Information

 
Prefix
(Select One)
♦
First Name
 
 
M.I.
 
♦
Last Name
 

 
Address
 
City
 
St./Prv.
 
Zip/Pst. Code
 
Country
 
Phone Number (Preferred)
Please include the area code, extension,
and/or dialing codes if applicable.
 
Personal/Business Email
(Format: username@domain.com)

Additional Details

 
Details

Surveillance Video

Video
♦
Was this incident captured on surveillance Video?
(Select One)
 
+
♦
♦
(Select One of Each)
♦
(Select One of Each)
♦
(Select One of Each)
0.
x
 
   

Outside Agencies(i.e. Law Enforcement, regulatory agencies, etc.)

Outside Agencies
♦
Were any Outside Agencies involved in this case?
(Select One)
 
♦
Using the input controls below, create a list of agencies related to this case.
(At least one agnecy is required)

 
  • Name ▼
  • Type
  • Contact Last Name
  • Contact First Name
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******


Agecny

 
Type
****
 
Name
****

 
Tracking / Report Number
****

Contact

 
Prefix
Mr.
 
First Name
Raymond
 
M.I.
M
 
Last Name
Bodnar

 
Title
****
 
Badge / Employee ID
****

 
Phone Number (Preferred)
****
 
Personal/Business Email
****


Agency

♦
Type
(Select One)
♦
Name
(Select One)

 
Tracking / Report Number
 

Contact

 
Prefix
(Select One)
 
First Name
 
 
M.I.
 
 
Last Name
 

 
Title
 
Badge / Employee ID


 
Phone Number (Preferred)
Please include the area code, extension,
and/or dialing codes if applicable.
 
Personal/Business Email
(Format: username@domain.com)

Vehicles

Vehicles
♦
Were there any vehicles involved in this case?
(Select One)
 
.
♦
Using the input controls below, create a list of vehicles related to this incident.
(At least one vehicle is required, two is the maximum)

 
  • Make ▼
  • Model
  • Year
  • License
  • State
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******


 
Vehicle Make
****
 
Vehicle Model
****
 
Year
****

 
Vehicle Color
****
 
License
****
 
State
****

 
Description
****


 
Vehicle Make
(Ex: Ford, GMC, Chevrolet)
 
Vehicle Model
(Ex: Truck, Van, Sedan)
 
Year

 
Vehicle Color
 
License
 
State
(Select One)

 
Description
 

Lost and/or Damaged Items

Items
♦
Were there any items lost and/or damaged in this case?
(Select One)
 
♦
Using the input controls below, create a list of items related to this incident.
(At least one item is required)

 
  • Item Name ▼
  • Type of Item
  • # of Items
  • Gross
  • Net
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******
1.
  • ******
  • ******
  • ******
  • ******


Item / Product Information

 
Type of Item
****
 
Department
****
 
Model Number or UPC
****
 
Item Name or Card Issuer
****
 
Description
****

Financial Impact

 
Value of the item lost, and value recovered.

 
Number of Items: 
Value (per unit): 
Gross Loss: 
Recovered: 
Net Loss: 
Loss/Stolen
 
0.00
$
0.00
$
0.00
$
0.00
$
0.00
Damaged
 
0.00
$
0.00
$
0.00
$
0.00
$
0.00
Total
 
0.00
$
0.00
$
0.00
$
0.00
$
0.00
 


Item / Product Information

♦
Type of Item
(Select One)
♦
Department
(Select One)
 
Model Number or UPC

♦
Item Name or Card Issuer

 
Description
 

Financial Impact

 
What was the value of the item lost, and was any value recovered?

 
♦
Number of Items:
Value (per unit): 
Gross Loss: 
Recovered: 
Net Loss: 
Loss/Stolen
 
$
$
$
$
Damaged
 
$
$
$
$
Total
 
$
$
$
$
 

Password

 
♦Password
♦
Re-Enter Password
Password

(Passwords must be at least four(4) characters in length.)

Submit

Upon submission of this form, you will be issued a Report Key. Please write this information down along with your password, in a secure and private place. Neither your report key, nor your password, can be recovered, or reset once this report has been submitted.

Using your Report Key and Password you can "Follow-Up" on this report returning to this form and clicking on the “Follow-up” link at the top of the page.

Follow-up will allow you to:

  • Upload documents
  • Respond to follow-up questions/comments
  • Provide additional information
   
Copyright © 2000 - 2024 NAVEX Global, Inc. All Rights Reserved.
Privacy Statement | Terms of Use