Reporting and consultation in the public interest – RERF Hiroshima

Please fill in the information required below and send this form by clicking the send button. It would also be acceptable to fill out the “Form for Report/Consultation” (Form 1) and attach it to this form. If substantiating or other documents exist, please attach copies of the documents to this form and press send.
* There is no need to fill out every column.

Informant's name
Anonymity requested	* If this reporting/consultation is anonymous, notification of the investigation results will not be made and an adequate fact-finding investigation may not be possible. Anonymity requested
Informant's affiliation
Informant's address
Email
Details of report
Documentary and other evidence Yes	Written form Other
For those choosing "Other," please indicate the title, name, or other information.
Documentary and other evidence No	No
Notification of progress/ final results of investigation	Yes No
Attached file(s)	× * RERF is scanning all incoming e-mail attachments for viruses. Even though no virus is detected on attached files, we delete files turned out "unsecure."
Image authentication	Please input the five alphanumeric characters that are displayed.

Personal information provided in this form will be handled appropriately, in accordance with the “Basic Policy of Radiation Effects Research Foundation Concerning Protection of Personal Information” and the foundation’s “Regulations for Protection of Personal Information.“