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2. Please provide as much information as possible.

   This form is for reporting concerns regarding general harassment, sexual harassment, discrimination, and/or workplace bullying. Submitted forms are sent directly to Human Resources for review and investigation regardless of whether or not an actual law appears to be violated. Complaints may be submitted anonymously, though that may impair our ability to follow up with the complainant following the investigation.

4. Your Information

   There is no need to complete this section if you wish to remain anonymous. Please keep in mind that if we are not able follow up with you it may impact our ability investigate fully if we have follow up questions. 

6. First Name
7. Last Name
8. Email Address
9. Phone Number
13. Incident Information

    Please provide as much detailed information as possible. These sections are required.

15. Date and Time of Incident*
    Date and Time of Incident

    Date and Time of Incident
16. Location of Incident*

    Please include the building and location within the building.

18. What type of incident are you reporting?*
    -- Select One --General HarassmentSexual HarassmentDiscriminationBullyingOther
19. If you selected Other, what type of incident are you reporting?
21. Name or Description of Person(s) Involved:*
23. Are there any witnesses?*

    1. Yes
    2. No
24. If so, please share names and/or descriptions.
26. What happened?*

    In your words, please share what happened. 

28. Thank you for taking the time to notify us of the situation.
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field