By submitting this complaint I am declaring under penalty of perjury under the laws of the State of California, that:
* Items marked with an asterisk (*) are required
To be completed by Supervisors/Managers only!
Date and Time notified of potential violation/observation was made:
Did you ascertain whether complainant(s) are in need of:
Did you advise the complainant(s) that they:
Optional: Please provide the following information below for statistical purposes:
Note: After you select 'Submit' you will not be able to go back and edit the form. Please contact the County Intake Specialist Unit to make changes to this form
The County Office of Equity investigates only claims relating to employees and contractors of the departments, commissions, and workplaces of the Los Angeles County Government.
If you are NOT an LA County employee or contractor and have experienced or witnessed harassment or discrimination in the workplace, please click on the HELPFUL RESOURCES menu tab and select NON-COUNTY AGENCIES for organizations that can help you file a claim or get assistance.