Racial Grievance Reporting Form
Please use this form to report a racial grievance to Seattle Works. If you request follow up, a Seattle Works representative will reach out to you within three business days to learn more about the incident and work with you to determine next steps for addressing the grievance. Your responses will be sent to the Director of Operations and the Chair of the Diversity, Equity, and Inclusion Committee.

Summary of Racial Grievance Policy
Seattle Works is building an anti-racist culture of belonging, where people can show up being their true selves, and accountability and is working to model anti-racist practices in our institutional and personal behavior. The racial grievance policy is to support people of color to feel safe in the Seattle Works community and to actively address and interrupt microaggressions, harassment, racial discrimination, and other racial misconduct. Our racial grievance policy is grounded in the lived experiences of people of color and our commitment to addressing and reducing racial grievances in our community. Seattle Works’ culture is growing to be truly more representative, so people of color in our community have organizational support and feel safe.

You can access our full racial grievance policy at www.seattleworks.org/racialgrievancepolicy, including definitions of racist incidents, steps for reporting and addressing racial grievances, contact information for Seattle Works representatives, and confidentiality and protection from retaliation.

Are you reporting a racial grievance about a racist incident that happened to you or someone else? *
If you are reporting for someone else, do you have their permission to report the incident? *
Name of person reporting the incident. If you wish to report anonymously, please leave this blank.
Your answer
Contact information for person reporting the incident (email and/or phone number). If you wish to report anonymously, please leave this blank.
Your answer
Please describe the location, circumstance, date and time, and description of the incident. If you are reporting on behalf of someone else, please include their name if you have permission from them. If you need more space, please email info@seattleworks.org with additional information. *
Your answer
Name of offender(s), if known
Your answer
Use this space to provide any other information about the offender.
Your answer
Have you experienced or witnessed a similar racist incident before, with or without the same offender? If so, please describe here.
Your answer
Did you or anyone else take action to interrupt or address the incident? *
If yes, what action was taken and what was the result?
Your answer
If no, why was no action taken?
Your answer
Is there any additional information you would like to share?
Your answer
Would you like follow up from a Seattle Works representative to address the racial grievance? *
Submit
Never submit passwords through Google Forms.
GoogleForms
This content is neither created nor endorsed by Google.