Formal Ethics Complaint Submission

To address potential ethical misconduct by ATSA members, please use this digital form for submitting formal complaints.

Pre-Submission Checklist:

  1. Review ATSA Code of Ethics: Access the ATSA Code of Ethics on our website for critical information and guidance. This includes resources and procedures for effectively resolving ethical concerns and complaints.
  2. Ethics Complaint Release of Information: It's crucial to read and understand the Ethics Complaint Release of Information form provided below. Completing this form will authorize the release of information as detailed within.
  3. ATSA Procedures for Filing an Ethics Complaint: Familiarize yourself with these procedures to ensure your complaint adheres to our established guidelines.

Submission Process:

  • Complete this ATSA Formal Ethics Complaint form and the accompanying Release of Information form.
  • Attach any additional supporting documents or materials.

Important Note:

  • The ATSA Ethics Committee's ability to act on complaints may be limited if they are submitted anonymously. For a comprehensive review and action, providing identifiable information is recommended.

Please verify that you have checked the “I'm not a robot” checkbox.

Your First Name

Your Last Name

Your Phone Number

Your Email

The name of the subject of your complaint.

The address of the subject of your complaint.

The phone number of the subject of your complaint.

The email of the subject of your complaint.

Please provide a detailed description of the facts supporting the complaint

Steps taken to address the situation and results thereof

Specific Standard(s) potentially violated:

Supporting Documentation

20MB max

Please describe the contents of your attachment and supporting documentation.

By Submitting the information in this complaint I affirm:

  • I have obtained any required permission to release the included documentation to the ATSA Ethics Committee, and the release of these documents does not to the best of my knowledge violate HIPAA, or any other state, local, or federal law.
  • An inquiry against the subject member based on the allegations outlined in this complaint may be initiated.
  • The ATSA Ethics Committee Chair may disclose all information I have provided to the ATSA Ethics Committee members, appropriate ATSA staff, legal counsel, and experts involved in handling the complaint.
  • The ATSA Ethics Committee will assure the responsible use of all information obtained.
  • The ATSA Ethics Committee may need to review and request personally identifiable information. This information will be used only for purposes of this complaint, and it will be maintained in a confidential file.

By Checking this box I Confirm Reading and Agreeing to the Ethics Complaint Release of Information