Equity and Human Rights

Discrimination and/or Harassment Reporting Form

This form is to be used to report behaviour that may contravene Western’s Policy on Discrimination and Harassment. The procedure for making a report is outlined at Section VII 1 and 1.01 of Western’s Non-Discrimination and Harassment Policy – Administrative Procedures (and similar sections within employee agreements). Please note that submitting this form does not mean that action will necessarily be taken. In most cases, you will be offered a confidential consultation with Equity & Human Rights Services (EHRS). EHRS will normally respond to this report within 48 hours (2 working days).

The information you submit will be sent to EHRS via email. If you prefer, you can print a PDF version of this form, fill it out by hand and send it to our office via campus mail.

All reports are maintained as per the practices of Equity & Human Rights Services (EHRS), including confidentiality and file retention. Should you require this form in an alternate format, or need assistance completing this form, please contact EHRS at 519-661-3334.

Please note EHRS does not provide copies of this completed form. Please ensure you print and retain a copy for your own records, if desired.

* indicates required fields

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    • Email
    • Phone

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  • Western's website
  • Referred by a supervisor or other Western leader
  • Through a training session or workshop
  • Word of mouth by a friend/colleague

By submitting this completed form, I acknowledge that this information will be maintained as per the confidentiality & file retention practices of Equity & Human Rights Services.

(NOTE: If you wish to retain a copy of this information for your records, please print this page BEFORE you click the Submit button.)