Respectful Workplace Complaint Form

The State of Minnesota, Minnesota State and Bemidji State University/Northwest Technical College are committed to providing a respectful and professional workplace and public service environment for employees, students and third parties. Respect for one another is fundamental to working in an effective, efficient and innovative manner. Disrespectful or unprofessional communications and behavior can disrupt the proper functioning of work units. Therefore, it is the intent of the State of Minnesota to ensure a respectful workplace and public service environment free of disrespectful or unprofessional communications or behavior; and provide effective and non-retaliatory problem-solving processes that address concerns regarding respectful or professional communications or behavior Reports submitted here are not continually monitored and will typically be reviewed on the next business day. This form is intended for use by students, employees, vendors, visitors or other concerned parties of both BSU and NTC to report specific information related to our Respectful Workplace Policy and Procedure. This is a secure reporting format accessible only to BSU/NTC Campus Human Resources Officer, Megan Zothman. You are not required to complete the entire form in order for the complaint to be submitted. The University/College will use the information provided to address the complaint, which may include informal and/or formal resolution along with additional conversations with you, others listed in this form and/or appropriate supervisor(s). Retaliation is prohibited against any employee, student or third party who initiates a complaint, reports an incident that may violate this policy, participates in an investigation related to a complaint, or is associated or perceived to be associated with a person who initiates a complaint or participates in the investigation of a complaint under this policy.

Anonymous complaints are accepted via the online Respectful Workplace Complaint Form. If you wish to remain anonymous, please note Human Resources will not be able to contact you directly to discuss your complaint. All efforts to address anonymous complaints will be taken in an effort to correct any disrespectful and/or unprofessional behavior.
Describe the specific incident(s) of disrespectful and or unprofessional behavior. List times, dates, locations, names and titles of the people involved in the incident(s).
Potential Witness 1
Potential Witness 2
Potential Witness 3
Max. file size: 16 MB.