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___ExamineeFamily/ Referral Source Complaint Form Date: Time: Facility/Doctor: Assessment Date: Referred By: Name: Contact Info: Describe your complaint or concern: (write on the back if you require

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How to fill out discrimination and retaliation complaints

01

Identify the specific incident of discrimination or retaliation that occurred.

02

Gather any supporting documentation or evidence to strengthen your complaint.

03

Contact the appropriate governing body or HR department to obtain the necessary forms to file a complaint.

04

Complete the required forms accurately and thoroughly, providing as much detail as possible.

05

Submit your complaint according to the specified deadlines or procedures.

Who needs discrimination and retaliation complaints?

01

Employees who have experienced discrimination or retaliation in the workplace.

02

Individuals who have witnessed discrimination or retaliation against others and wish to report it.

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What is discrimination and retaliation complaints?

Discrimination and retaliation complaints refer to formal grievances filed by individuals alleging unfair treatment or retaliation based on protected characteristics such as race, gender, age, disability, or other factors.

Who is required to file discrimination and retaliation complaints?

Individuals who believe they have been subjected to discrimination or retaliation in the workplace or in other contexts are required to file complaints.

How to fill out discrimination and retaliation complaints?

Discrimination and retaliation complaints can be filled out by providing personal information, details about the incident(s), the nature of the discrimination or retaliation, and any supporting evidence.

What is the purpose of discrimination and retaliation complaints?

The purpose of these complaints is to seek relief for perceived injustices, ensure accountability, and encourage fair treatment by promoting a discrimination-free environment.

What information must be reported on discrimination and retaliation complaints?

Information that must be reported includes the complainant's contact information, details of the incident(s), description of the discrimination or retaliation, and any relevant witnesses or documentation.

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