This form is to be used if you wish to submit a formal complaint of harassment or discrimination under the Respectful Work and Learning Environment Policy. By submitting this form, you are requesting a formal investigation into your complaint.

The decision on whether to proceed with a formal complaint shall be made by the Human Rights and Equity Office in consultation with legal counsel and Human Resources (where relevant) in accordance with section 23 of the Respectful Work and Learning Environment Procedures. Please complete all the sections below to ensure the University has the necessary information to assess your complaint.

If you have any questions about completing this form, please contact the Office of Human Rights and Equity at humanrights@brocku.ca.

PRIVACY NOTICE: Brock University protects your privacy and your personal information. The personal information requested on this form is collected under the authority of The Brock University Act, 1964, and in accordance with the Freedom of Information and Protection of Privacy Act (FIPPA). The information will be used for the purpose of assessing your request for formal investigation under the Respectful Work and Learning Environment Policy and determining appropriate measures. The information provided on this form may be provided to the named Respondent(s), their representatives, and those University employees directly involved in administering the Respectful Work and Learning Environment Policy and Procedures. If you have any questions about the collection of information on this form, please contact humanrights@brocku.ca.