Harassment and Discrimination Complaint Intake Form

The City will not tolerate any form of harassment or discrimination, nor will it tolerate any form of retaliation against employees or other individuals who complain about harassment or discrimination or participate in any investigation concerning harassment or discrimination.

Any individual encountering harassment or discrimination is encouraged to inform the offending individual that his or her actions are unwelcome and offensive. The complaining party is encouraged to document all incidents of harassment, discrimination, or retaliation. Any individual who believes that they have been subjected to harassment, discrimination, or retaliation is strongly encouraged to file a complaint. Complaints should be filed within 30 days of the most recent alleged adverse action or incident. All complaints are confidential until the investigation is complete or inactive and/or a finding is issued.

Complainant Information

* Complainant Name:

* Best Daytime Phone Number:

Additional Phone Number:

* Email Address:

Complaint Information

* Date of Most Recent Incident:

* Which department do you work for?

* Please explain what you mean by other?

* Please be specific as to what occurred. Include the date the incident occurred, name(s) of individual(s) committing the alleged harassment or discrimination, name(s) of witness(es) and what they witnessed, and the place the incident occurred. Cite any specific statements made, whether you expressed disapproval of the accused individual's conduct/behavior, etc.

* Signature (click "Save Signature" when done signing)