The Rock County HSD Compliance Committee has created a form that individuals can use to report concerns regarding non-compliance as outlined in the HSD MA Compliance Plan. All responsible parties who are responsible for reporting concerns with non-compliance and the HSD Compliance Committee will investigate those concerns to the best of our ability in a non-retaliatory, transparent manner. Individuals reporting by using the form have 3 methods of reporting that are outlined on the form. Those methods are:

• Confidentiality and Anonymity are not requested
• I wish to remain Confidential
• I wish to remain Anonymous

As stated above, all investigations are completed in a non-retaliatory manner, and the HSD Compliance plan has a whistle-blower clause to protect reporters who are concerned and reporting in good faith. The HSD Committee and members respect all reporters’ decisions as to their status of reporting. We ask whichever status a reporter selects, please include as much detail as you are able to provide. We will follow up with reporters that do not choose to remain anonymous. For those that do wish to remain anonymous, the more detail we have, the more thorough investigation we are able to complete. While the reporting form is our preferred method of reporting suspected non-compliance, we also provide alternative ways to report via email, supervisor/manager contact, or telephone contact.

Reporting non-compliance is everyone’s responsibility. We appreciate everyone’s cooperation and adherence to the Rock County Human Services Department’s MA Compliance Plan.

Forms and Resources

Reporting Form
HSD Compliance Plan
Code of Conduct
HSD MA Compliance Training