City of Philadelphia | Equal Employment Opportunity (EEO) and Sexual Harassment Complaint Form

If you believe you have experienced discriminatory, harassing (to include sexual harassment), or retaliatory conduct, please fill out the complaint form with as much detail as possible.

* required information

Your information

Name*

First Last

Gender

Race

Payroll number

(if you work for the City)

City department

(if you work for the City)

Home address*

Street Address City State ZIP code

Preferred phone*

Work phone

Preferred email address

The accused’s information

Name

First Last

Gender

Race

City department

(if they work for the City)

Position, title, or other descriptor

Your complaint

If you’ve experienced more than one occurrence, enter the date and location of the first occurrence below. Provide details about additional occurrences under Description of Complaint.

Date of occurrence*

Location of occurrence*

Basis for complaint*

Please list the protected category(ies) that is the basis for filing this complaint. Can include: race, ethnicity, color, sex, sexual orientation, gender identity, religion, national origin, ancestry, age, disability, marital status, source of income, familial status, genetic information, or domestic or sexual violence victim status.

Description of complaint*

Please describe the occurrence in as much detail as possible. Include dates, times, locations, comments, gestures made, names of other persons directly involved, etc.

Witness(es)

Please provide name and contact information of witness(es). Either email address or phone number.

Corrective action sought

Please explain what outcome you are seeking as a result of filing this complaint.

Agreement

By typing your full name below, you agree to submit this information to the City of Philadelphia’s Department of Labor, Office of Employee Relations.*

City of Philadelphia Equal Employment Opportunity (EEO) and Sexual Harassment Complaint Form

If you believe you have experienced discriminatory, harassing (to include sexual harassment), or retaliatory conduct, please fill out the complaint form with as much detail as possible.

Your information

The accused’s information

Your complaint

Agreement

Please review your information below before submitting this form, then click on Edit to make changes, or click on Submit to complete this form.