Adopted: August 2006
Revised: July 2023
To: Human Rights Officer:
Director of Human Resources (employee or nonstudent conduct)
Director of Elementary Education (student conduct, grades K-5)
Director of Secondary Education (student conduct, grades 6-12)
Director of Special Education (concerns relating to a student’s disability, including their rights under Section 504)
From: , Principal/Designee/Other (circle one)
_________________________________________________ , ________________________________________
Position School
Date:__________________________________
Subject: Fifteen-Day Follow-Up Report on Complaint of Harassment, Discrimination, Violence or Hazing
Approximately 15 days ago I completed the investigation of a harassment, discrimination, violence or hazing complaint based on (check all that apply):
□ sex □ national origin □ gender identity
□ race □ marital status □ age
□ religion □ familial status □ genetic information
□ color □ disability □ status with regard to public assistance
□ creed □ sexual orientation □ membership or activity in a local human commission
in which I found that the complaint was substantiated.
I have checked with the complainant to determine if the harassment, discrimination, violence or hazing has ceased or if it continues. The complainant reports that it has: ceased continues
I would also like to inform you that
Signature of Investigator X Date
Signature of Complainant X Date