Self-Reporting Violations


Self-Reporting Violation Form

Dos and Don’ts

  1. Use this form when you wish to Self-Report a PCard violation (whether overt or unintentional) for:
    • Using a PCard for personal purchase or
    • Using a PCard for any other purpose which is against University policy
  2. If there is a credit/refund from the vendor of the charges expensed, please do not fill out this form. Instead, please cross-reference the transaction on both eDocs in UAccess Financials (i.e. eDoc on which the original purchase was reported and the eDoc on which the refund is reported).
  3. Please do not use this form for not reconciled or unauthorized sharing of a PCard. Contact Accounts Payable at 520-621-9097 or

Line-by-Line Instructions

Line 1: Today's date

Line 2: The responsible user is the individual for whom the charges are incurred. If the responsible user is the Business Manager or Department Head/Director, see instructions to Line 5 and Line 6. Include the Employee ID number from UAccess.

Line 3: The responsible card holder (if different than user above) is the individual responsible for the card as listed in UAccess Financials.

Line 4: The PCard Liaison is designated to serve by the Department Head/Director.

Line 5: The Business Manager or equivalent is the individual responsible in the Department’s Business Office. If the Business Manager or equivalent is the Responsible User for the transactions, then the next level Manager in the Business Office is required to sign the violation.

Line 6: The Department Head/Director is the individual responsible for overseeing the entire Department. If the Department Head/Director is the Responsible User for the transactions, then the next level of Management is required to sign the violation.

Line 7: The Department name and number is required.

Line 8: The exact name as it appears on the PCard that was charged. Please do not use the nicknames of the Cardholder.

Line 9: Transaction ID as it appears in UAccess Financials.

Line 10: The date the transaction is posted (as it appears in UAccess Financials).

Line 11: The eDoc number as it appears in UAccess Financials

Line 12: The Merchant name as it appears in UAccess Financials.

Line 13: The exact dollar amount of the charge as it appears in UAccess Financials.

Line 14: Indicate the type of violation.

  • Personal Purchase: Personal expenses like preferred seating, early bird check-in, optional charges (such as insurance) on rental vehicles, alcohol purchase, donations, gifts, tipping over 20% of the total bill, any purchase without a valid University business purpose, etc. must be reimbursed to the University. Please note that this list is not all inclusive. If you have any questions, please contact Financial Compliance.
  • Other: Please summarize the nature of the violation and note the specific policy violated.

Line 15: Space for additional explanation of why the policy was violated. Please attach an additional page if the space provided is insufficient.

Line 16: Copies of all the documents associated with the PCard transaction - Departmental PCard form, business purpose, invoices, receipts, etc.

Line 17: A copy of the UAccess Deposit/Cash Receipt showing the credit to the original Account and Object Code expensed or some similar proof if the deposit was auto posted. If the employee requests a payroll deduction, provide amount. Reimbursements of $100 or more may be split in in more than one pay period. 

  • Note: If reimbursement to the University was not completed at the time the self-report violation form is sent to Financial Compliance, a payroll deduction will automatically be processed

Line 18: Acknowledge that a self-reported violation carries the same weight as a violation issued by Financial Compliance. These actions may occur depending on the severity and number of violations.

Line 19: Obtain the required signatures.

Line 20: Attach a copy to UAccess Financials under Notes and Attachments, and AddHoc to group 1062191 - FNSV AP Financial Compliance.

If you have any questions about this form or the process, please contact Financial Compliance at 520-621-9097 or