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Investigation Completed by: ______________________________ | |
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Date Investigation Completed: ______________________________ | |
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Date Investigation Report Completed (if different from above): ______________________________ | |
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Employee(s) Involved: ______________________________ | |
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Employee Dates of Hire: ______________________________ | |
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Employee’s Manager: ______________________________ | |
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Date Issue was Brought to Attention: ______________________________ | |
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Name of Person(s) Who Raised the Issue: ______________________________ | |
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Description of allegations (check all that apply): |
☐ racial discrimination/harassment ☐ age discrimination/harassment ☐ gender discrimination/harassment ☐ discrimination/harassment based on national origin ☐ discrimination/harassment based on color ☐ religious discrimination/harassment ☐ discrimination/harassment based on disability or medical condition ☐ ancestry discrimination/harassment ☐ discrimination/harassment based on marital status ☐ discrimination/harassment based on sexual orientation ☐ discrimination/harassment based on gender identity ☐ discrimination/harassment based on genetic information ☐ discrimination/harassment based on pregnancy ☐ discrimination/harassment based on veteran status ☐ retaliation ☐ unfair treatment ☐ favoritism ☐ theft or misappropriation of intellectual property/confidential information ☐ bribery/corruption ☐ fraud ☐ falsification of records ☐ violation(s) of gifts/entertainment policy ☐ conflicts of interest ☐ threats or violence in the workplace ☐ privacy policy violation ☐ safety violation ☐ other inappropriate behavior |
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Brief summary of allegations: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ | |
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Is there any interim action that was taken while the investigation was pending? ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ | |
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Description of Company policies/ employee agreements that might be involved (where marked, attach a copy of those policies to the final report): ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ | |
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Are there likely documents or other information that might lead to information that would support or refute the claims? If so, identify such documents and what steps will be taken to locate those documents or items: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ | |
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If you did not interview any of the persons identified by the person complaining or about whom the complaint was made, state the reason here: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ |
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List of interviews conducted (name, date, approximate length of the interview, any other relevant information): | |
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Name/Title: Date: Length Of Interview: |
Name/Title: Date: Length Of Interview: |
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Name/Title: Date: Length Of Interview: |
Name/Title: Date: Length Of Interview: |
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Name/Title: Date: Length Of Interview: |
Name/Title: Date: Length Of Interview: |
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Summarize the course of the investigation and witness interviews: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ | |
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Summary of Investigation ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ | |
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Summary of Interviews ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ | |
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Findings and Conclusions of Investigator: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ | |
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Prior Relevant Incidents: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ | |
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Recommendations for Next Steps: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ | |
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Follow-Up: ________________________________________________________________ ________________________________________________________________ ________________________________________________________________ |