Privacy Initial Report Form

The purpose of this Security or Privacy Initial Report Form is to allow employees to quickly and easily report any incident or suspicious activity, whether technology or human based, in accordance with policy. 

It is of the utmost importance that ALL incidents are reported in the most timely manner possible. Reporting an incident quickly and properly can possibly mitigate the risk of a breach, and prevent future incidents. Additionally failure to report known incidents could result in fines against RRS Medical and its employees.


There is no wrong instance for reporting. If it seems possibly wrong to you, or possibility of adverse to a patient, it should be documented using this proper form.  


To complete a Security or Privacy Initial Report Form Please click the link to the right.

At RRS Medical, we will conduct business fairly, impartially, in an ethical manner and in complete compliance with the law.  Our business conduct must be guided by the highest level of integrity when dealing with our customers, patients and employees.  Employees can not engage in any activity that could call into question the Company’s honesty, impartiality or reputation.  Employees must obey all applicable laws and regulations governing our operations anywhere we conduct business.  
Each team member bears the responsibility to ask questions, seek proper guidance and report suspected violations of our Ethical standards.  Please follow the company standard practices, talking to employee, supervisor, HR, etc. for reporting  issues or concerns.  If for any reason, a team member desires anonymity in reporting a concern, he or she is encouraged to use the hotline thru lighthouse services.  They are available 24/7.   


Reports may cover but are not limited to the following topics:
Ethical violations                           Theft and Embezzlement
Unsafe Working Conditions         Vandalism and Sabotage    
Quality of Service                          Misuse of Company Property    
Sexual Harassment                        Bribery and Kickbacks    
Discrimination                                Fraud    
Alcohol and Substance Abuse     Conflict of Interest 
Threats                                            Falsification of Contract, Reports or Records
Violation of Company Policy        Violation of the Law


Note:  We will not tolerate any retaliation against employees who raise genuine concerns.  Such retaliation is cause for disciplinary action up to and including termination of employment.  The information provided by you may be the basis of an internal and/or external investigation into the issue you are reporting and your anonymity will be protected to the extent possible by law by Lighthouse. However, your identity may become known during the course of the investigation because of the information you have provided.   Reports are submitted by Lighthouse to a company designee for investigation according to our company policies.


•    Website:
•    Toll-Free Telephone:
o English speaking USA and Canada: 855-580-0088
o Spanish speaking USA and Canada: 800-216-1288

•    E-mail: (must include company name with report)

•    Fax: (215) 689-3885 (must include company name with report)