BEFORE COMPLETING THE FORM, PLEASE READ THE FOLLOWING INFORMATION CAREFULLY.
Why fill out this form?
If you are a survivor of sexual violence, filling out the following form will allow you to disclose the situation and make initial contact with the Human Rights Office, whose mandate is to respond to incidents of sexual violence. The form is not used to disclose all the details of the incident, nor to file a formal complaint, but rather to receive support as well as relevant information to help and guide you through the various services and options available.
If you prefer to speak to someone in person, feel free to contact the Human Rights Office at 613-562-5800, ext. 5222 or firstname.lastname@example.org.
If the situation is urgent, please contact Protection Services at 613-562-5411.
What to expect?
Following receipt of the form, a Sexual Violence Prevention Officer from the Human Rights Office will contact you within 24 to 48 business hours, with the exception of University of Ottawa vacation days and statutory holidays. You can then schedule a meeting to further discuss the situation and obtain information on different resources, Policy 67b - Prevention of Sexual Violence, complaint options and on accommodations and interim measures.
Confidentiality and Notice of Collection of Personal Information
This form is confidential. Once completed, the form will only be received by the Human Rights Office and will not be shared unless you or a third party is at risk of harm. In this case, you will be notified of the steps that will be taken. Your personal information is collected under the authority of the University of Ottawa Act, 1965, In accordance with the Freedom of Information and Protection of Privacy Act of Ontario and with University Policy 90.
You can fill out the form anonymously. However, if you do not provide a method for us to contact you, the ability of the Human Rights Office to respond or take action will be limited. Please note that there are some questions that are mandatory (*) for the University to provide statistical information.
If you have any questions about the collection of information by means of this form, please contact the Human Rights Office at 613-562-5800, ext. 5222 or email@example.com.
While completing this form, it is possible that emotions, images or negative memories occur. Do not hesitate to seek support. Here are some services that can help you:
For more information on available resources, visit Sexual Violence: Support and Prevention