Fillable AAEO Prohibited Conduct Complaint Form (Discrimination/ Harassment/ Retaliation/ (Oregon Health Sciences University)

Fill Online, Printable, Fillable, Blank AAEO Prohibited Conduct Complaint Form (Discrimination/ Harassment/ Retaliation/ (Oregon Health Sciences University) Form

Use Fill to complete blank online OREGON HEALTH SCIENCES UNIVERSITY pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

AAEO Prohibited Conduct Complaint Form (Discrimination/ Harassment/ Retaliation/ (Oregon Health Sciences University)

On average this form takes 13 minutes to complete

The AAEO Prohibited Conduct Complaint Form (Discrimination/ Harassment/ Retaliation/ (Oregon Health Sciences University) form is 3 pages long and contains:

  • 1 signature
  • 27 check-boxes
  • 34 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Oregon Health Sciences University

BROWSE OREGON HEALTH SCIENCES UNIVERSITY FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Rev. 4/29/20 AAEO Complaint Form Page 1 of 3
AAEO Prohibited Conduct Complaint Form
(Discrimination/ Harassment/ Retaliation/ Sexual Misconduct)
Complete this form and return it to the Affirmative Action & Equal Opportunity Department (AAEO)
PLEASE PRINT OR TYPE- ATTACH EXTRA SHEETS IF NECESSARY
1. Name:
Your pronouns:
Mailing Address:
City: State: Zip Code:
Preferred Phone: Preferred Email:
Best time of day to contact:
Employee ID #: Job Title:
Manager/Supervisor (if applicable):
Department/School/Academic Program, if student:
Shift Hours:
Days Off: Mon Tues Wed Thurs Fri Sat Sun Rotating Variable
2. Identify the individual(s) and/or Department that you allege engaged in prohibited conduct:
1.
2.
3.
3. Indicate the basis for your complaint (prohibited discrimination/harassment/retaliation/sexual
misconduct):
4.
5.
6.
Age
Disability (includes accommodations)
Race/Color
Medical/Sick Leave (use of)
Sex/Gender
Marital Status
Military/Reserve/Veteran Status
National Origin/ Ethnicity
Pregnancy
Sexual Misconduct
Religion (includes accommodations)
Retaliation (based on protected activity)
Sexual Harassment
Sexual Orientation
Harassment and/or bullying (based on
protected class)
Whistleblower
Worker’s Compensation System (use of)
Other:
Rev. 4/29/20 AAEO Complaint Form Page 2 of 3
Note: If referral is appropriate, your complaint may be directed to the Human Resource Department,
the Integrity Department, to your Union (if you are a classified employee) or other appropriate OHSU
department.
4. Briefly explain the prohibited conduct you believe happened (use supplemental sheet(s), if
necessary):
a. On what date(s) did the alleged incident(s) occur?
b. Explain the incident(s) that occurred:
c.Is this a recurring problem? If yes, please explain:
d. Name potential witnesses:
5. Was any explanation given for this conduct? (If yes, please explain):
1.
2.
3.
5.
6.
Rev. 4/29/20 AAEO Complaint Form Page 3 of 3
6. Have you attempted to resolve the concern?
7. What resolution would you like to see for yourself and others?
8. Are you interested in learning about informal resolution options?
Please include any documentation that you believe is relevant to your complaint
Signature of person filing complaint:
Name: Date:
Submit your form to the OHSU Affirmative Action and Equal Opportunity Department (AAEO) via email,
confidential fax, hand delivery, or U.S. Mail. Please call AAEO with questions: 503-494-5148.
Email: aaeo@ohsu.edu
Fax: 503-346-8037
Hand deliver to: Marquam Plaza, 2525 SW 3
rd
Avenue, Suite 240, Portland, OR 97201
U.S. Mail: AAEO
Oregon Health & Science University
Mail code: MP 240
3181 SW Sam Jackson Park Road
Portland, OR 97239
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

AAEO Prohibited Conduct Complaint Form (Discrimination Harassment Retaliation (Oregon Health Sciences University)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 24 August 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document