HomeMy WebLinkAboutOCDSB 653 Respectul Workplace-Questionnaire November 2009
Respectful Workplace Questionnaire
(References: Policy P.119.HR and Procedure PR. 652.HR)
Where the parties involved in a workplace conflict are unable to resolve the conflict, the complaint will proceed to Stage 3 in the process and a
complaint review may be conducted. This Questionnaire, completed by both parties – Complainant and Respondent – will assist with the fact-
gathering process. Please ensure your answers are as specific and detailed as possible.
Confidentiality will be maintained at all stages as far as practicable and appropriate under the circumstances, subject to the rights of the person
against whom the complaint is made to be treated fairly.
Name(s) of individual(s) making the complaint: (please include position and work location):
Name: Employee ID:
Position: Location:
Name(s) of individual(s) the complaint is being made against (please include position and work location):
Name: Employee ID:
Position: Location:
Personal information on this form is collected under the authority of the Education Act and will be used for respectful workplace procedure purposes. Questions
regarding the collection should be directed to the Manager of Human Resources, 133 Greenbank Road, Ottawa, ON K2H 6L3 (613) 596-8211..
1. Please describe in detail the specific incident that occurred. (Please provide date(s), time(s), where incident occurred)
2. How did the complainant’s behaviour make you feel (eg. hurtful words, belittled, bullied)?
3. How have you contributed to this conflict (eg. did you retaliate, make remarks, ignore concerns of complainant)?
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4. What steps have you taken to resolve or remedy the situation (eg. did you tell the person his/her actions were inappropriate; did you report the
incident to your supervisor, Union Rep, Harassment Prevention Coordinator )?
5. What would you like the Board to do as a result of your complaint (eg. what remedy are you seeking?)
6. A detailed record of the events is crucial. Please include, as an attachment to this questionnaire, any relevant information (eg. copies of emails,
notes/records of what happened, any materials or other evidence) pertaining to this complaint. If there are any new developments that have arisen
since the initial complaint, please indicate them below.
7. List and identify any witnesses to the incident(s) or persons who have personal knowledge of the information pertaining to your complaint, and for
which we may contact: (please include name, position, and work location)
I certify that, to the best of my knowledge, the information contained in this Questionnaire is accurate and true.
I have attached supportive evidence and/or documentation that will assist the Employer in making recommendations for resolution and I will fully
cooperate in the Board’s investigation of this complaint.
I understand the Board may interview witnesses (named in this questionnaire) or others who may have relevant information to provide in this case. I
have the right to Federation/Union representation should the Board wish to interview me in person regarding this matter.
Should the conflict not be resolved, the final resolution of the complaint shall be made by the Manager, Human Resources. I understand that any
actions, decisions, or remedies taken will be based solely on non-discriminatory consideration of all the facts found in the course of the file review.
Employee’s Signature: Date:
Teachers Please Note – the Teaching Profession Act, Section 18.1b (Duties to a Member to Fellow Members) requires ‘A member shall, on making
an adverse report on another member, furnish him with a written statement of the report at the earliest possible time and not later than three days
after making the report.’
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