Abusive Conduct Complaint Intake Form

This form should be used to report alleged violations of the Abusive Conduct in the Workplace Policy. You can see the Abusive Conduct Policy.

If you are experiencing an immediate safety threat or emergency, please call 911 immediately.

Definitions

Reporter: Any individual, including a student, who makes a report of alleged misconduct that falls under the Abusive Conduct Policy.

Complainant: Any individual, including a student, who alleges and/or has been reported to have been subjected to abusive conduct.

Respondent: An individual alleged to have engaged in abusive conduct.

Workplace: Any space where University business is conducted or occurs, in connection with University employment and/or in the context of a University program or activity (for example, University-sponsored study abroad, research, health services, or internship programs, as well as the online workplace).

Please see reference of the Abusive Conduct Policy.

Today's Date

Date of Incident

If conduct has taken place on more than one date, please indicate the initial date here and include additional dates below in the Description of Conduct section.

Are you reporting for someone else as a Reporter?

If you are reporting alleged Abusive Conduct on behalf of someone else, you may do so anonymously. However, UC employees reporting on behalf of a student or subordinate employee must provide their name and other information to fulfill their reporting responsibilities.

Yes

Are you reporting for yourself as a Complainant?

Yes

Are you participating as a Respondent?

Yes

Have you previously attempted to address this matter with your supervisor, your manager, Office of Ombuds, Title IX Office, or Office of Human Resources?

Yes: Please enter details in box below

Details

Are you seeking informal or formal resolution?

Informal

Formal

If seeking informal resolution, do you grant permission for the Office of the Ombuds to contact you for assistance?

Yes

Reporter Information

If not the Complainant, each question below requires a response; if any of the requested information about the Reporter is unknown, please write “Unknown”.

Reporter Name

Reporter Email

Reporter Phone Number

Phone

Reporter Job Title

Reporter Department (If Known)

Other Reporter

Complainant Information

Each question below requires a response; if any of the requested information about the Complainant is unknown, please write "Unknown".

Complainant Name

Complainant Email

Complainant Phone Number

Phone

Complainant Job Title

Complainant Department

Other Complainant

Respondent Information

Each question below requires a response; if any of the requested information about the Respondent is unknown, please write “Unknown".

Respondent Name

Respondent Email

Respondent Phone Number

Phone

Respondent Job Title

Respondent Department

Other Respondent

Description of Conduct

Please include a description with details as follows:*

What occurred, what was said, when the incident(s) occurred, where the incident(s) occurred, who else was present at the time of the incident(s), along with any other relevant information.

If there were any witnesses to the alleged misconduct, witness names should be provided, along with contact information, if known. If you need additional space to describe the behavior being reported, please attach another document with the details.

Requested Outcome*

Please outline the requested outcome the Complainant is seeking from this complaint.

Please submit any supportive documentation here (Upload file)

This includes, but is not limited to, documents, pictures, emails, screenshots of texts, etc.

Drag and drop files here or

Send me a copy of my responses

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