Romero House Potters Grievance Report Form

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Please use this form to report an incident of harassment or discrimination connected with Romero House Potters (RHP). All reports are reviewed by RHP's Vice Chair and the RHP Safety Committee. All grievance reports will be treated as confidential to the extent possible while addressing the grievance.

Are you reporting a grievance about an incident of harassment or discrimination that happened to you or someone else?

Myself

Someone else

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Would you like to report anonymously?

Yes

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If you would like to share your name please give it here.

If you would like to share your email and/or phone number you may do so here. Remember we can not report back to you if we do not have some kind of contact information.

Would you like follow up from a RHP representative to address the grievance? We must have some kind of contact information to do this.

Yes

Other:

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