Report Employee Fraud Submitted by dlfaison on Mon, 04/06/2026 - 15:38 Report employee Fraud. Name of person you suspect is committing fraud Address Address Address 2 City/Town State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Date of birth (if known) IC# (if known) Details about the improper or fraudulent activity you suspect such as: exceeding physical limitations, working while receiving benefits, malingering, reporting false claims, or a staged accident in violation of N.C.G.S. §97-88.2. Provide details about the improper or fraudulent activity you suspect Type of injury Date of injury (if date unknown, use winter, spring, etc and approximate year) Name of employer at the time the injury was sustained Name of employer at the time the injury was sustained (if known) Employer address Address of employer or Self-employed business Address 2 City/Town State/Province - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming ZIP/Postal Code Employer Phone number Do you have documentation that supports your complaint such as: videos, social media, photographs, payroll records, additional witnesses, falsified documents, activity level with a vivid description of activity? Yes, I have documentation No, I do not have documentation Your relationship or involvement with the suspected person(s) List agencies this incident has been reported to Name of Agency Operations Name of Agency Email Address If you want to receive a copy of your submission data, please include a valid email address Phone number
