Statement of Purpose

The Investigation Report Form is intended for use by El Pollo Loco Human Resources team to create investigation files. The investigation files are created to record any violation or potential violation of EPL policy, state or federal law, or the Code of Business Ethics & Conduct.

Use this report form to communicate any violation or potential violation of EPL policy, state or federal law, or the Code of Business Ethics & Conduct.

Items marked with a diamond ♦ are required fields.

Your Information (You, the person completing the form)

	Saved Data Save “Your Name & Contact Information” for future use. (By checking this box you agree to allow NAVEX to store your information in a “Cookie” on this computer.)

Your Name & Contact Information	♦ First Name M.I. ♦ Last Name ♦ Job Title

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

Reporter	♦ Was this issue/event raised by another individual? Yes No (Select One)

Reporter Name & Contact Information	♦ Relationship to Company (Select One) ♦ “Other” Relationship Prefix (Select One) ♦ First Name M.I. ♦ Last Name Employee ID ♦ Phone Number (Preferred) Include the area code, extension, and/or dialing codes if applicable. Phone Number (Alternative) Include the area code, extension, and/or dialing codes if applicable. Email (Format: username@domain.com) ♦ Position at the Company (Select One) ♦ Other Position at Company

Reporter Name &
Contact Information

♦

Relationship to Company

(Select One)

♦

“Other” Relationship

Prefix

(Select One)

♦

First Name

M.I.

♦

Last Name

Employee ID

♦

Phone Number (Preferred)

Include the area code, extension,
and/or dialing codes if applicable.

Phone Number (Alternative)

Include the area code, extension,
and/or dialing codes if applicable.

(Format: username@domain.com)

♦

Position at the Company

(Select One)

♦

Other Position at Company

Location

Location	General Manager Area Leader

Issue Selection

Incident Details

Date	♦ Approximate date of issue/incident. (Format: mm/dd/yyyy)

Details	♦ 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.

Previously Reported	♦ Has this issue/incident been previously reported? Yes No Do Not Know (Select One) ♦ Approximate date of when was this previously reported? (Format: mm/dd/yyyy) ♦ To whom was this previously reported?

Inquiry / Ask a Question

Inquiry	♦ Provide the details of your inquiry/question

Participants (Including but not limited to “Implicated Persons”, “Accomplices”, and/or “Witnesses”)

Participants	♦ Were any “Participants” involved in this incident? Yes No (Select One)

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