EEO: Filing Harassment / Discrimination Complaint

Director: Jesse L. Burnette

More Information:

EEO Complaint Process

Filing Harassment / Discrimination Complaint

The County of Erie prohibits harassment or discrimination because of gender, race, color, national origin, ancestry, religion, creed, physical or mental disability, marital status, age, sexual orientation, genetic predisposition, military status, domestic violence victim status, request for reasonable accommodation under the Americans With Disabilities Act ("ADA"), use of leave under the Family and Medical Leave Act ("FMLA") or any other basis protected by Federal, state or local law. The County of Erie also prohibits retaliation, in any form, against an individual who makes a complaint of harassment or against any participant in an investigation of harassment. If you believe you have been harassed, discriminated against or retaliated against in violation of County of Erie policy, please complete this complaint form.

Please fill out the on-line complaint form below and click "Submit Complaint," or click here to download a printable version (pdf)

General Information

Date:

Name:

Address:

City:

State:

Zip:

Home Phone #:

Work Phone #:

Department:

Supervisor's Name:

Supervisor's Phone #:

Specific Information About Your Complaint

1. WHO IS HARASSING YOU, DISCRIMINATING AGAINST YOU AND/OR RETALIATING AGAINST YOU? [Include name(s) and job title(s)

2. WHAT HAPPENED TO YOU TO PROMPT THIS COMPLAINT? [Be as specific as possible in describing the harassment/discrimination/retaliation. Include names, dates and locations. Try to describe the "who, what, why, when, where and how" of the incident(s).

3. DID ANYONE WITNESS THE INCIDENT(S) DESCRIBED ABOVE? IF SO, STATE THE NAME OF THE INDIVIDUAL WHO WITNESSED EACH INCIDENT.

4. WITH WHOM HAVE YOU DISCUSSED THE INCIDENT(S):

5. HAVE YOU PREVIOUSLY BEEN SUBJECTED TO HARASSMENT, DISCRIMINATION OR RETALIATION BY THE INDIVIDUAL(S) IDENTIFIED IN YOUR RESPONSE TO QUESTION NUMBER #1? IF SO, PLEASE DESCRIBE EACH PRIOR INCIDENT IN DETAIL. [Include names, dates, and locations]. Try to describe the "who, what, when and where, why and how" of the incident(s).

6. DO YOU HAVE WRITTEN DOCUMENTATION [e.g. cards, letters, diaries, journals or calendars] RELEVANT TO YOUR COMPLAINT? IF SO, DESCRIBE THE DOCUMENTS (S).

7. ARE YOU AWARE OF OTHER EMPLOYEES WHO HAVE EXPERIENCED HARASSMENT, DISCRIMINATION, OR RETALIATION BY THE PERSON HARASSING, DISCRIMINATING OR RETALIATING AGAINST YOU? IF SO, STATE THE EMPLOYEE'S NAME AND THE DETAILS OF HIS/HER EXPERIENCES, IF KNOWN TO YOU.

8. HOW DO YOU SUGGEST OR PREFER THAT YOUR COMPLAINT BE RESOLVED?

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Welcome to the Division of EEO

Erie County Division of Equal Employment Opportunity

EEO Complaint Process

Filing Harassment / Discrimination Complaint