Miami DSA Harassment and Grievance Reporting Form
This is the confidential harassment and grievance reporting form for Miami DSA. This reporting form is for reports of harassment outlined in the National Harassment Policy (Resolution 33) and for other forms of misconduct outlined in the Miami DSA bylaws.By filling this out, your report will be officially filed and the Miami DSA Harassment Grievance Officer (HGO) will reach out to you to initiate a formal organizational response. Please allow up to 48 hours for a Miami DSA HGO to follow up with you after filing a report. Note that you have the option of filing reports of harassment at the local level with the form, or at the National level. If you would prefer to file a confidential grievance with the National Grievance Officer, please do so here: https://docs.google.com/forms/d/e/1FAIpQLSe4Ra7UifhPsSYvxMgE6TvBYzXf8OVyBuzt9byKyxYgUYXUEA/viewform
Reporting Member Name
Optional, you can remain anonymous if you choose.
Reporting Member Email or Phone Number
*
Required, but does not have to be an address we recognize. Feel free to create an email address for the purpose of managing this request.
Name of Reported Member
*
Please specify the name of the member whose actions you are reporting.
Click Here if Filing a Collective Grievance
Yes
No
Collective Grievance: Reporting Members
Please provide names and contacts for other reporting members if part of a collective grievance.
Description of the Incident
*
Please provide a detailed description of why you believe there has been a violation of DSA’s Harassment Policy, including the date(s) and location of the behavior you're reporting, a description of the incident(s), the names of individuals who may have information about the incident other than those filing the grievance, whether there is any relevant documentation, what resolution are you are seeking, and any other details you would like to provide to the HGO.
Jared and Valeria are the HGOs for Miami DSA
Of the people listed above, are there people who you would prefer to follow up with you?
If so, please list their names in the box below.
Of the people listed above, are there people who you absolutely DO NOT WANT following up with you?
If so, please list their names in the box below.
Submit
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