Formal complaint form against Discrimination

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Formal complaint form against Discrimination

(To be filed within ninety (90) days of the alleged occurrence)

  1. Name of Complainant:

 

  1. Department:

 

  1. Today’s Date:

 

  1. Name of person (s) accused of the alleged occurrence:

 

  1. Department: 

 

  1. Date of alleged occurrence (Write the day, date, time and location):

 

  1. Name of Person(s) who witnessed alleged occurrence:

 

  1. Please write a detailed description of the occurrence:

 

 

 

 

 

  1. What remedy are you seeking?