Harassment Reporting Form

This form is for SoCal ETC or Visit San Pedro employees and volunteers to report harassment of any kind. All allegations will be investigated and, if appropriate, acted upon. No one reporting harassment will be subject to any kind of retaliation.

Your name

Approximate date harassment began

Please tell us the approximate date that the behavior you consider harassment began. This does not have to be an exact date, but should be to the best of your recollection.

Approximate date harassment ended

Please tell us the approximate date that the behavior you consider to be harassment ended. If it has not ended, leave this field blank.

Name of harasser(s)

Name of harasser(s)
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Please tell us the name(s), if known, of any individuals who have harassed you in relation to this complaint. If you do not know their names, include their titles or a description that might help us identify them.

Description of harassment

Description of harassment
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Please describe the harassing behavior you experienced.

Category of protected class

Gender

Check this box if you believed the harassment or discrimination was because of your gender

Race

Check this box if you believe the harassment or discrimination was because of your race or ethnicity

Religion

Check this box if you believe the harassment or discrimination was because of your religion

Gender identity

Check this box if you believe the harassment or discrimination was because of your gender identity

Physical, mental, or medical

Check this box if you believe the harassment or discrimination was because of a real or perceived physical, mental, or medical condition

Marital status

Check this box if you believe the harassment or discrimination was because of your marital status

Veteran status

Check this box if you believe the harassment or discrimination was based on your actual or perceived status as a veteran or non-veteran

Other

Check this box if you believe the harassment or discrimination was based on some other legally protected status

Other categories

If you checked "other" types of discrimination, please enter the protected class that you are a part of

Reported

Check this box if you have previously reported this matter to anyone, whether verbally or in writing

Reported to

If you checked the box that you have previously reported this matter, please tell us the name of the person or entity to whom you reported it

Reported date

If you checked the box that you have previously reported this matter, please tell us the date you reported it

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