Discrimination, Harassment and/or Retaliation Incident Reporting Form

Prior to completing this form, please review the institution's policy on non-discrimination and anti-harassment and policy and procedures related to sexual harassment and violence.

Reporting Knowledge Center

You are not required to complete the entire form in order for the complaint to be submitted, but please complete it to the best of your ability. The complaint will be forwarded to the Office of Human Resources (OHR) for review to determine the appropriate action. OHR may contact the complainant, respondent, and/or any potential witnesses. However, if the form does not contain specific information, the institution's review and response may be limited.

This form is designed to provide an online method to report specific information related to an alleged incident or incidents of workplace discrimination, harassment and/or retaliation. In lieu of completing this form online, you may contact staff and faculty relations to discuss alternate methods to report. You may also contact Clemson University's anonymous ethics/safety hotline either online or by calling 1-877-503-7283.

Complainant's Information

Complainant is the person who is reporting a concern or concerns for further review.

Current Mailing Address

Involved Parties

Please identify the person or persons whom the complaint is made against.

Person 1

Person 2

Person 3

Person 4

Questions

While providing details is essential to investigating your complaint, please be advised that some or all of the information you provide in this section may be shared with the person or persons you are accusing. So, if you want to decide later to provide more details, you may supplement the original form at a later date.

Please check the following boxes that you feel describe or categorize this event (check all that apply).

  

  

  

  

  

  

  

  

  

  

  

  

  

If this is a sexual violence, sexual misconduct or sexual harassment complaint, please indicate the category of the alleged behavior.

  

  

  

  

  

  

  

Supporting Documentation