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

Please complete this form to the best of your ability; however, the form does not need to be completed in its entirety for the complaint to be submitted. If the form does not contain specific information, the institution's review and response may be limited. The Office of Human Resources may contact the complainant, respondent, and/or any potential witnesses. Confidentiality will be maintained to the extent possible under the law.

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.

Please note: Some incidents identified on this form may be covered by Title IX and will be initially provided to the Title IX Coordinator for review. If you prefer, you can file an incident report directly with the Title IX Coordinator. If you’re unsure if the incident should be reported on this form or directly to the Title IX Coordinator, please complete this form to the best of your ability and the Office of Human Resources will forward the form to the Title IX Coordinator if appropriate.

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. The categories below may be covered by Title IX and may be initially reviewed by the Title IX Coordinator. If you prefer, you may file an incident report directly with the Title IX Coordinator. Please see the Title IX website for more information.

  

  

  

  

  

  

  

Supporting Documentation