Case Resolution Request Form Quick Escape Confidentiality and Notice of Collection of Personal Information This form is encrypted. Once submitted, your completed Case Resolution Request Form (with attachments) will only be received by the Human Rights Office (HRO) . The information will be added in the HRO Case file system and be treated in a confidential manner and 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 of Ottawa`s Policy 90 Access to Information and Protection of Privacy. The communications and information provided to the HRO will not be shared unless you or a third party is at risk of harm. Please note that, under the Occupational Health and Safety Act (OHSA) all known incidents of workplace harassment, including sexual harassment, need to be investigated even when no formal complaint has been made. In this case, you will be notified of the steps that will be taken. For statistical, accountability and public reporting purposes, the HRO reports on statistics that will include your complaint/concern. However, no identifying information will be included in any such report. Please note that there are some questions that are mandatory (*) to allow the University to provide the necessary statistical information. All individuals involved in a report or an investigation of harassment, discrimination, sexual violence or a a breach of responsible conduct must keep the matter confidential in order to safeguard individuals against unsubstantiated allegations, to protect the rights of those involved in the allegation and to preserve the integrity of the investigation. 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 respect@uottawa.ca . Next Step If your matter falls within the mandate of the HRO and you would like the HRO to proceed, you will need to submit a signed copy of the Authorization and Consent Form to the HRO. This will authorize the HRO to access any information in the possession of the University of Ottawa that may be relevant to this matter and authorize personnel and/or organizations within the University of Ottawa to disclose information on your files to the HRO in accordance with the applicable policy and process under Policy 67a - Prevention of harassment and discrimination, Policy 67b – Prevention of Sexual Violence and/or Policy 130 - Student Rights and Responsible Conduct. Your Information Some questions are mandatory (*) to allow the University to provide statistical information. An anonymous allegation may be considered if it consists of sufficient, substantive and verifiable information and if anonymity of the Complainant does not prejudice the fairness of the Investigation. Please note that if you do not provide your personal information and a method for us to contact you, the ability of the Human Rights Office to respond or take action will be limited. Although the Human Rights Office will not give your name to anyone in your workplace, we cannot guarantee that the person involved in the complaint and the complaint process won’t guess that you are the complainant. We also cannot guarantee that you will remain anonymous if there are other proceedings. First Name Last Name Address Postal Code Phone Number Email address Affiliation * - Select -StudentEmployeeOther If other, please specify Position Held Student/Employee Number Union or Other Representative INDIVIDUAL/DEPARTMENT COMPLAINED ABOUT Name/Department Name Address Postal Code Phone Number Email PARTICULARS OF COMPLAINT Please provide details of your complaint/concern, including dates, times and a description of the incident(s) as well as the names of possible witnesses. Further details can be provided on a separate sheet. 1. What happened? * 2. Who was involved? * 3. When did it happen? * 4. Where did it happen? * 5. Were there witnesses? * Yes No witnessesName 6. Details 7. What area(s) and ground(s) of the Human Rights Code (the Code) do you believe were violated? * Age Ancestry, colour, race Citizenship Ethnic origin Place of origin Creed Disability Family status Marital status Gender identity, gender expression Record of offences (in employment only) Sex (including pregnancy and breastfeeding) Sexual orientation Not applicable Not sure Prefer not to answer What sub-categroy area(s) do you believe were violated? * Anti-Black racism Anti-Indigenous racism Antisemitism Islamophobia Other: please specify Not applicable Not sure Prefer not to answer PRIOR ACTION Have you already tried to resolve your complaint/concern? * - Select -YesNo If yes, it would be helpful for you to provide the following information : Who did you contact? When? What action was taken? informations DESIRED OUTCOMEPlease note that the HRO is a neutral office and does not serve as an advocate for any of the parties. How do you think this matter could be best resolved? * Please attach documents you feel will support your case. Files must be less than 2 MB.Allowed file types: jpg jpeg png pdf doc docx. If you add extra pages, please sign, date and number each additional page. Form sign * By signing this Case Resolution Request Form, you confirm that you have requested the assistance of the Human Rights Office (HRO) in addressing your complaint/concern and that you have read and understand the Confidentiality and Notice of Collection of Personal Information statements. In addition, you are stating that the information you provided is all relevant information, and that it is true, to the best of your knowledge and belief. sendCopy I would like to get a copy of my form (email must be provided) Learn more about Harassment and Discrimination.
