Sexual Harassment Complaint Record by cln12100

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									                                                     CONFIDENTIAL                       Discrimination and Harassment
                                                                                              Complaint Record


                    (Note: Sexual Harassment grievances are managed separately under policy 1.70.2)

              This form should be completed by the Supervisor, Manager, to whom a complaint of
                                discrimination or harassment has been made.
             Send completed form to the Director, The Equity Office, marked CONFIDENTIAL


Interviewee Name: (if disclosed) _______________________________________________________________

Contact details: (School/Centre/Admin Unit) _______________________________________________________

(phone) ____________________ (email) ________________________________ (other) __________________


INFORMATION ABOUT THE CASE
Claimant:

    Academic              General                 Student            Other              Female           Male
     staff                  staff                                 (eg friend, parent,
                                                                  visitor)
(If disclosed)

    Indigenous            CALD*                   Disability        Other
     Australian                                                   (eg GLBTI**
                                                                  particular religion)

Respondent:

    Academic              General                 Student            Other              Female           Male
     staff                  staff                                 (eg friend, parent,
                                                                  visitor)
(If disclosed)

    Indigenous            CALD*                   Disability        Other
     Australian                                                   (eg GLBTI**
                                                                  particular religion)

Dates of alleged occurrence (s): ______________________________________________________________________

Location of alleged occurrence(s): ____________________________________________________________________

Details:




* Culturally and Linguistically Diverse background
** Gay, Lesbian, Bisexual, Transgender, Intersex

The University of Queensland                                      1           Discrimination and Harassment Complaint Record
Action taken: (eg information provided, consultation with The Equity Office, resolution achieved)




Follow up:




Comments:




Supervisor / Manager/

Name: ________________________________________ UQ address: ______________________________

Telephone number: _______________________                           Email address:_____________________________



       I have advised the interviewee (claimant or respondent) that an allegation of discrimination or
        harassment is a serious matter that needs to be handled by all parties with an optimal degree of
        confidentiality.

       I have advised the claimant that the disclosure to parties without a ‘need to know’ of an allegation of
        discrimination or harassment might constitute defamation of the respondent.

       I have informed the interviewee about issues related to victimisation.



Signature: _______________________________________
                  (Signature of supervisor/manager)

Date:       /     /


Return completed form to the Director, The Equity Office, Building 69, St Lucia Campus
Please mark envelope CONFIDENTIAL

The University of Queensland                                   2          Discrimination and Harassment Complaint Record

								
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