Complaint Form

Welcome to EOD Discrimination Complaint System
Last Name: First Name: Middle Initial:
Email Address:
Primary phone:
Alternate phone:
Home Address:
City:
State:
select
Zip code:
Are you presently working for the State of Ohio?  
Check the appropriate area(s) of discrimination:








Check the appropriate area(s) of Discriminatory harassment:








Check if you have experienced Retaliation based on your involvement with a current or previous complaint of discrimination or harassment:  
What is your Race?
select
What is your Sex?
select
Employee Status:
select
Name of the agency you believe discriminated against you:
Enter the Name(s) and title(s) of person(s) you believe discriminated against you:
Have you filed a complaint that involves similar issues with the federal Equal Employment Opportunity Commission (EEOC)?
Have you filed a complaint that involves similar issues with the Ohio Civil Rights Commission (OCRC)?
Have you filed a Union grievance regarding the incident(s)?
Most recent date of alleged discrimination: 
RadDatePicker
RadDatePicker
Open the calendar popup.
State Agency where you were employed at the time of alleged discrimination:
select
Job Title at the Time of Alleged Discrimination: 
What employment related decision was influenced, impacted, or related to the alleged discrimination, harassment, or retaliation?







This explanation section is very important. Please describe how the acts of discrimination, harassment, or retaliation were because of your status (age, race, gender, etc.) and resulted in the employment-related decision you selected above. For discrimination or retaliation only describe details, conversations, or information that occurred on the date you listed above. For harassment please describe details, conversations, or information that occurred on the date you listed AND on past dates to demonstrate the harassment was ongoing. Be as specific and clear as you are able. You may add attachments if necessary.

Complaint Submitted by:
You will have the opportunity to attach supporting documentation to this complaint after you select "Submit Discrimination Complaint".
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