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Internal Agency Communication

  • Internal Agency Communication Form, for:

    • Anonymous Reporting of Inappropriate Practices/Behavior

    • Anonymous Suggestions/Concerns to Agency Director


In an effort to foster safe and authentic work place experiences at TICC, the Internal Agency Communication form is offered so that team members can comfortably communicate suggestions or report harmful or unethical workplace experiences. This form allows team members to anonymously share suggestions or report harmful/unethical behaviors, though if you wish to receive follow-up communications about what you've shared then you will need to select "Contact Me" and include the desirable method of contact.

If you would like more information about Inappropriate Practices/Behaviors in the workplace, HERE is an overview focused on workplace discrimination, harassment and sexual harassment as contained in TICC's Workplace Harassment Policy. However, it is not comprehensive, so if you are unsure of your experiences after consulting this policy, it would be best to review Kentucky workplace laws (public access online) or the Codes of Ethics for the respective licensures (accessible in Staff Portal) for issues related to Counseling Ethics & Professional Behaviors.

Internal Agency Communication Forms

When using this form, only complete the information fields in the first portion of the form for suggestions/concerns, unprofessional behavior, or staff success stories. If only submitting a communication involving the first portion of the form, you may submit the communication anonymously if desired. You may also elect to include name and contact information if you'd like to receive follow-up communication from the appropriate TICC personnel whether it be an office administrator, co-director, or founder/clinical director.

If you are reporting workplace discrimination, harassment, or sexual harassment, your name and contact information is necessary for appropriate investigation of the reported behavior. Please refer to TICC's Workplace Harassment Policy prior to submitting a report.
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Multi-Purpose Message Field

Complete the below information fields only if reporting workplace discrimination, harassment, or sexual harassment:

Check all that apply:
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