Military Informal Discrimination Complaints

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					                                               MILITARY INFORMAL DISCRIMINATION COMPLAINTS

                                                                                        BASIS OF ALLEGED DISCRIMINATION

                                                                                                         GENDER         NATIONAL
               TYPE OF COMPLAINT (ISSUES)                      RACE         COLOR           REL                                         REPRISAL   TOTAL
                                                                                                        M         F      ORIGIN

 SEXUAL HARASSMENT
 OTHER HARASSMENT
 EVALUATIONS
 TRAINING
 DISCIPLINARY ACTIONS
 PROMOTIONS
 ASSIGNMENT OF DUTIES
 REENLISTMENTS
 PROVOKING SPEECH/GESTURES
 UCMJ ARTICLE I38
 ACTIONS BY SUPERVISORS
 DISCHARGE




                                                CIVILIAN INFORMAL DISCRIMINATION COMPLAINTS

                                                                            BASIS OF ALLEGED DISCRIMINATION

                                                                                  SEX             NATIONAL
   TYPE OF COMPLAINT (ISSUES)           RACE           COLOR          REL                                    REPRISAL      DISABILITY        AGE   TOTAL
                                                                              M         F          ORIGIN

 PROMOTION/APPOINTMENT
 HARASSMENT (NON-SEXUAL)
 DISCIPLINARY ACTIONS
 HARASSMENT (SEXUAL)
 ASSIGNMENT OF DUTIES
 PERFORMANCE EVALUATION

U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5618 (6-04) Page 1
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         THE COAST GUARD'S INITIAL CONTACT TRACKING FORM
   FOR MILITARY/CIVILIAN DISCRIMINATION COMPLAINT PROGRAM

This form is to be completed by Military Civil Rights Counselor/Facilitators (MCRC/F's) and
EEO Counselors hereafter will be referred to as Counselors. Counselors will complete this
form when a contact is made by an aggrieved person and/or anyone seeking information
as it relates to the discrimination complaints process. Upon completion, please send the
form to the appropriate Civil Right's Officer in your Area of Responsibility:



REGARDING THE AGGRIEVED PERSON:


1. Name (Last, First, MI):

2. Organization and Location (City/State):


3. Reason for Contact: Information:                              Counseling:

4. Date of this Contact:                                Name of Counselor:

5. Contact was made: Telephonically:                          or In person:

6. Counselor's Telephone #:




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U.S. DEPT. OF HOMELAND SECURITY, USCG, CG-5618 (6-04)