DSA-LA Grievance and Misconduct Report
This is the confidential grievance and misconduct reporting form for DSA-LA. This reporting form is for reports of harassment outlined in the National Harassment Policy (Resolution 33) and for other forms of misconduct outlined in the DSA-LA Misconduct Policy.

By filling this out, your report will be officially filed and the DSA-LA Harassment Grievance Officer (HGO) will reach out to you to initiate a formal organizational response.

Please allow up to 48 hours for a DSA-LA HGO to follow up with you after filing a report.

Note that you have the option of filing reports of harassment at the local level with the form, or at the National level. If you would prefer to file a confidential grievance with the National Grievance Officer, please do so here: https://docs.google.com/forms/d/e/1FAIpQLSe4Ra7UifhPsSYvxMgE6TvBYzXf8OVyBuzt9byKyxYgUYXUEA/viewform

Email address *
Reporting Member Name *
Your answer
Name of Reported Member (Please specify the name of the member whose actions you are reporting) *
Your answer
Click here if filing a collective grievance (If this grievance is on behalf of two or more individuals, please select 'yes') *
Collective Grievance (Please provide names and email addresses for other reporting members if part of a collective grievance.)
Your answer
Description of the Incident. Please provide a detailed description of why you believe there has been a violation of DSA’s Harassment Policy, including the date(s) and location of the behavior you're reporting, a description of the incident(s), the names of individuals who may have information about the incident other than those filing the grievance, whether there is any relevant documentation, what resolution are you are seeking, and any other details you would like to provide to the HGO. *
Your answer
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