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If you are a staff member who feels that you are a victim of workplace harassment, please let ASDB know using this form. This complaint process applies whether the alleged harasser is another staff member, a student, or a third party. Your complaint will be forwarded to the Human Resources Office.

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  • If yes, list the name, job title, work location, telephone number of any person to whom you described the incident(s); the date or approximate date you brought the incident to the other individual’s attention.
  • If yes, list the name, job title, work location, telephone number of the employee(s).
  • I certify that this information is true and correct to the best of my knowledge. I am willing to cooperate fully in the investigation of my complaint and to provide whtever evidence ASDB deems relevant. I understand that in order to investigate my complaint, it will be necessary to interview you, the alleged harasser(s), and any witnesses with knowledge of the allegations or defenses. I further understand that ASDB will notify all persons and witnesses involved in the investigation that it is confidential and that unauthorized disclosures of information concerning the investigation could result in disciplinary action up to and including discharge from employment.

  • Please type in your name for your electronic signature
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