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EQUITY DATA FORM FOR REPORTING ALL CASES OF HARASSMENT OR

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EQUITY DATA FORM FOR REPORTING ALL CASES OF HARASSMENT OR Powered By Docstoc
					 DIVISION OF HUMAN RESOURCES AND EQUITY
                          http://hr.ukzn.ac.za


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        EQUITY DATA FORM FOR REPORTING ALL CASES OF HARASSMENT OR
                             DISCRIMINATION

Name of Person to who the matter was reported:



Extension:              E-Mail:



DETAILS OF COMPLAINANT:

   MALE                                            FEMALE
   ACADEMIC                                        SUPPORT
   PERMANENT                                       CONTRACT
   UNDERGRADUATE STUDENT                           POSTGRADUATE STUDENT
   LIVING IN UNIVERSITY RESIDENCE                  LIVING IN UNIVERSITY ACCOMODATION
   (ON CAMPUS                                      (OFF CAMPUS)
   AFRICAN                INDIAN                   COLOURED               WHITE
   OTHER RACE                                      AGE BELOW 20           AGE 20-30
   AGE 30-40              AGE 40-50                AGE 50-60              AGE OVER 60
   ASSISTED BY UNION                               ASSISTED BY SRC
   FACULTY OR DIVISION (Please Insert Below)       DATE/DATES OF INCIDENT




DETAILS OF RESPONDENT:

   MALE                                            FEMALE
   ACADEMIC                                        SUPPORT
   PERMANENT                                       CONTRACT
   UNDERGRADUATE STUDENT                           POSTGRADUATE STUDENT
   LIVING IN UNIVERSITY RESIDENCE                  LIVING IN UNIVERSITY ACCOMODATION
   (ON CAMPUS)                                     (OFF CAMPUS)
   AFRICAN                INDIAN                   COLOURED               WHITE
   OTHER RACE                                      AGE BELOW 20           AGE 20-30
   AGE 30-40              AGE 40-50                AGE 50-60              AGE OVER 60
   ASSISTED BY UNION                               ASSISTED BY SRC
   FACULTY OR DIVISION (Please Insert Below)       DATE/DATES OF INCIDENT




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NATURE OF DISCRIMINATION/HARASSMENT

    SEXUAL HARASSMENT                                       RACIAL HARASSMENT
    RACE                                                    SEX
    AGE                                                     ETHNICITY
    ORIGIN                                                  RELIGION
    LANGUAGE                                                SEXUAL ORIENTATION
    GENDER                                                  CULTURE
    POLITICAL AFFILIATION                                   PREGNANCY
    CHILDCARE                                               DISABILITY
    MARITAL STATUS                                          HIV AIDS STATUS


METHOD OF DISCRIMINATION/HARASSMENT

    TELEPHONIC                                              PHYSICAL
    VERBAL                                                  E-MAIL
    LETTER                                                  STALKING
    PORNOGRAPHIC MATERIAL                                   GESTURES
    INDECENT EXPOSURE                                       SEXUAL FAVOUITSM
    QUID PRO QUO


OUTCOME

    COUNSELLING                                             CRIMINAL CHARGE
    CONCILIATION                                            CLARIFICATION
    ARBITRATION                                             LEGAL ADVICE
    FORMAL COMPLAINT                                        UNFOUNDED
    STAFF MISCONDUCT                                        STUDENT DISCIPLINE
    REFERRAL TO DIVERSITY UNIT                              VEXATIOUS
    NO ACTION TAKEN


DETAILS OF COMPLAINT
Please provide a brief description of the complaint. You need not provide identifying details.




Forward completed forms to:
Diversity Unit, Third Floor
Administration Building
Westville Campus

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