Workplace Concern Notification to HR

Employees should use the Workplace Concern Notification to HR form in order to report behavior that does not maintain a respectful and productive work environment free from discrimination or harassment in accordance with Title VII and Bellevue University Policies PS6 and PS22.

This form is not intended to be used for personnel disputes, general expressions of dissatisfaction, or other workplace grievances. This form is intended to be used to report information about alleged employment discrimination or harassment on the basis of race, color, religion, sex, national origin, age, disability, genetic information, military obligations, or status in another class protected by law.

Is your workplace concern related to alleged employment discrimination or harassment?

• If yes, please complete the form below to submit your report.
• If no, please do not use this form. Contact Human Resources for additional guidance regarding your concern or issue.

Complete the information below and click on the submit button. Someone from Human Resources will contact you to gather additional information regarding your concern.

Fields in bold are required.