dinc, iitr, roorkee, grivance, suggestion, gallery, Diversity and Inclusion Committee

dinc, iitr, roorkee, grivance, suggestion, gallery, Diversity and Inclusion Committee

dinc, iitr, roorkee, grivance, suggestion, gallery, Diversity and Inclusion Committee

dinc, iitr, roorkee, grivance, suggestion, gallery, Diversity and Inclusion Committee

dinc, iitr, roorkee, grivance, suggestion, gallery, Diversity and Inclusion Committee
dinc, iitr, roorkee, grivance, suggestion, gallery, Diversity and Inclusion Committee
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GRIEVANCE FORM

Note :- All Astrick (*) Fields are mandatory.
Full name *
Designation*
Department*
Marital Status*
Category*
Mobile No.*
Email ID*
Date of incident *
Time of incident *
Nature of incident*
Location of incident*
Specific location (if any)*
Involved Parties (If an organization is involved, please list the organization or entity.)
Name or Organization
Relationship to Incident
Remove
Motive Information Select the perceived motive for the incident. Check all that apply.*
Bullying
Inappropriate verbal comment
Indecency/exposure
Intimidation
Physical attack
Property damage/graffti
Pursuit/chase
Sexual harassment
Vandalism
Discrimination from the administration
Discrimination/policy from faculty
Offensive visual representation
Harassment (Email, social media or Text message and phone)
Incident Information Select the incident. Check all that apply.*
Discrimination of Age
National origin/citizenship
Disability
Ethnicity
Gender identity/expression
Physical appearance
Religion
Sexual orientation/perceived sexual orientation
Other
Incident Information (in case of other)*
Please provide the facts of the incident (Describe max. 500 characters only)*
Please list witnesses to the incident, if any.
Please list other offices or staff members you have reported this incident to, if any.
Please upload any supporting documentation (pictures, screenshots, recordings, etc.)
Attachments require time to upload, so please be patient after submitting this form.
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