Write down the the Title and Phone
(N/A if it doesn't apply)
Please fill out the date(s) you filed the complaint. (N/A to skip)
The information you have provided will be kept confidential. Other parties are not notified about your complaint unless and until the assigned investigator determines that the complaint qualifies under the Human Rights Ordinance. Your written and signed authorization is required to begin an investigation. Notification to the Respondent and/or other outside parties will only occur with your signed authorization. However, in limited circumstances, information provided in this form may be disclosed without your signed consent. If HRO staff believes that you are likely to harm yourself or another person; or if a child or other vulnerable person has been abused or neglected; or if your records are requested by a valid subpoena or court order, then HRC staff may disclose information necessary to protect you or others by contacting law enforcement officers, local agencies, or a physician in such limited circumstances.
By electronically signing this from I acknowledge that I understand and accept the terms and conditions outlined above.
