City of Worcester

webmaster@worcesterma.gov

455 Main Street, Worcester, MA, 01608, US

City of Worcester Letterhead with City Seal and City Manager Eric Batista's Name

Investigations Division Intake Form

If you need assistance filling out this form, please contact the Executive Office of Diversity, Equity and Inclusion at 508-799-1995 or visit at 51 Sever Street, Worcester, 01609.

Phone Number

Are you a City employee?

Yes

In which department do you work?

Briefly in 1-3 sentences explain what happened that led you to reach out to us. Provide any identifying information for the individual you are reporting, including name, title, and department, as you are able.

Which of the following issues do you wish to report (check all that apply)?

Discrimination and/or Discriminatory Harassment

Sexual Harassment

Excessive Force

Please identify the best dates and times over the next two weeks to discuss this matter further with Investigations Division staff:

Complaints will be handled with as much confidentiality as possible in accordance with relevant laws and City of Worcester policies. Names are generally used for the purposes of EODEI record.

When meeting with Investigations Division staff, you will be asked to discuss the circumstances that were reported in this form. A formal complaint has not been completed until this meeting has taken place.