Respectful Workplace Incident Form

Please provide as much detail as possible. We are dedicated to preserving your anonymity to the fullest extent possible. However, please be aware that conducting a thorough investigation into workplace complaints can be challenging without complete information. Please read the complete Respectful Workplace Policy before submitting.

Type of incident(Required)

If you selected other, please describe the incident type.

Are you the complainant or a witness to the incident?(Required)

Complainant

Witness

Did this occur at the work place?(Required)

Yes, this took place in the work place.

No, this took place outside the work place.

Is this a single occurrence, or has the incident occurred more than once?(Required)

Single Incident

Multiple Incidents

Ongoing

Please provide details of the incident(s), including the location.(Required)

Provide as much detail as you are comfortable with. It is important to include location, date and time of the incident(s).

Please state the full name(s) and title(s) of individuals whom you suspect of wrongdoing.(Required)

Personal Information

IMPORTANT: This form can be submitted anonymously and is only directed to HR. The personal information below is not required, however, providing your name and email will allow an HR representative to reach out to you and expedite any necessary action.

Name

First Last

Please remember: If you need support while dealing with a respectful workplace incident, our Employee and Family Assistance Program (EFAP) is here to provide you with care and support.

Privacy

All incidents shall be communicated and resolved using the Company’s prescribed procedures. Each incident will be treated with confidentiality and due care. It is our policy that the person submitting the incident report will not be negatively affected in any way. We recognize the significance of this policy, and as such, deliberate false accusations are considered equally serious and will also result in disciplinary action up to and including termination without notice for just cause.

The Respectful Workplace Incident form is used to communicate appropriate incidents. Your identity will be protected, and you can choose to remain anonymous. If a name is provided, you will be contacted by our HR representative to discuss the incident to determine any action that may need to be taken. Please read the complete Respectful Workplace Policy before submitting.