U.S. Department of Labor

Incident Report: Discrimination Based on Sexual Orientation

This form was developed by Labor GLOBE to give DOL employees an opportunity to report incidents to DOL management. The form can be used to report discrimination, harassment, unusually positive treatment, or other DOL experiences related to sexual orientation in the DOL workplace. Information will be gathered by Labor GLOBE. The nature of the incidents, and names where permission is given by the person filling out the form, will be submitted to the DOL Office of Civil Rights at least quarterly. If you have any questions, please contact Diane Herz at [email protected] or 202-691-6383.

Name (Optional):                                

 


 Labor GLOBE can share the name with DOL management

Phone Number/Email (Optional):

 

Location of Incident:

 


 

Date/Time of Incident:

 

Explain What Happened:

 


 

 

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