Client or Staff Discrimination Complaint Form

Client or Staff Discrimination Complaint Form
FAO: Danielle Jones HR Manager Wagging4Walks Ltd.

Wagging4Walks Offices, Kingsheath Ave, L142DG.
What Date did the incident occur?

MonthDayYear
Date
What Time did the incident occur (Approx.)

Hour Minutes

AM/PM Option
Where did the incident occur?
Was the incident related to any of the following
In relation to the question above, Why do you believe this to be the case?
Are You:
Please tell us about your complaint. (Please be as detailed as possible; including witnesses etc).
Has this type of incident occurred before with this or these individuals?
What do we need to do as a company to satisfy your complaint?
Details of the Victim (or leave bland and see below)

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Details of the Witness or Complainant if not the victim.

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Please tell us how you would prefer to be contacted regarding this matter!
My gender at birth was?
I consider my gender to be/ or legally is?
I am aged
My ethnicity is?
If you are the victim; do you consider yourself to have a disability?
Signature of the person completing this form.

Clear
Thank you for completing this form.

We will acknowledge receipt of this form within 48hrs and aim to reply within 7 working days. In more complicated cases we will inform you of our progress, but it could take up to 6-8 weeks.

Relevant resources.

https://www.medicalnewstoday.com/articles/how-to-respond-to-racial-microaggressions

If you are a direct victim of Discrimination racism or otherwise, you can report the incident to Merseyside Police to handle as you may be a victim of a serious hate crime. Call 101 non-emergency or submit a form online.

Data Protection

Wagging4Walks Ltd will use the information you have provided on this form for Equal Opportunities monitoring purposes only. Completion and return of this form indicate your consent to the company processing your sensitive data where necessary. You have the right to apply for a copy of

We hold the information about you. You have the right to have any inaccuracies corrected.
Should be Empty: