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Employee Discrimination and Harassment Complaint Form
If you believe you have been subjected to discrimination or harassment in violation of Weber School Districts' policy 7100 Employee Harassment and Discrimination, please complete this form and it will be submitted to the Title VII Coordinator.  For questions please call the Human Resources Department at 801-476-7886.

Overview of Investigative Process
The Investigator will be promptly notified of this complaint. If additional information from you is needed, you will be contacted for a follow-up interview. The investigation will also include interviews with, and written statements from, the target, the person against whom the complaint is made, witnesses, and others identified as having pertinent information.

The investigator will consider all the evidence and will make findings of fact and conclusions as to whether any District policies have been violated. In the case of policy violation, disciplinary action may be taken against the respondent. Other actions may be taken to address the effects on the target and the school environment. To the extent legally permissible, the target and the respondent will be notified of these decisions.

Confidentiality
The investigation will be conducted in a reasonably confidential manner. However, witnesses and others with pertinent information may need to be made aware of the investigation and sufficient facts to elicit their verbal/written statements. The Investigator will take measures to protect confidentiality of the target and the accused, including directing all witnesses to refrain from disseminating information related to the complaint and investigation.

You should also keep the complaint and investigation confidential. Do not attempt to conduct your own parallel investigation or discuss the facts of your complaint with others.

No Contact
You should avoid contact with the accused. This includes written, electronic, verbal, and in-person contact. If contact with the accused is unavoidable in the school, please notify the investigator.

Office for Civil Rights
In addition to filing a complaint with the District, you may also contact the U.S. Department of Education, Office for Civil Rights, 1244 Speer Boulevard, Suite 310, Denver, CO 80204-3582; Telephone No. 303-844-5695; Fax No. 303-844-4303; TDD No. 877-521-2172; Email OCR.Denver@ed.gov.
Email *
Email  *
School/Department *
Employee/Complainant Name: *
Respondent'(s) Name(s)*:
*Please list all names if more than one
 *
What is the basis of the discrimination: *
Description of the complaint:
Provide a brief summary of the incident(s)/conduct described by the complainant.  Include who, what, when, and where.
 *
Describe the harm caused by the incident above, inclusding any hostile environment, or other adverse effects: *
Describe the remedy you seek, including any assistance you may need to address the harm described above: *
Please list the names of any witnesses: *
Is Complainant/Employee fearful of retaliation? *
This complaint is based on my honest belief that I have been discriminated against or harassed as described above.  I hereby respresent that the information provided herein is true, correct, and complete to the best of my knowledge. *
A copy of your responses will be emailed to .
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