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OIE Team
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OIE Intake Form
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OIE Intake Form
OIE Intake Form
FOR INTERNAL USE ONLY: If you are not an OIE staff member, DO NOT USE THIS FORM.
Caller's Name
(Required)
First
Last
Caller's JHED ID
Have you verified this JHED ID in my.jhu.edu?
Caller's Email Address
(Required)
Caller's Phone Number
Caller's Preferred Method of Contact
(Required)
E-mail
Phone
Prefer Not to be Contacted
Unknown
Is the caller a Complainant, Responsible Employee, or Unknown/Other?
Complainant
Responsible Employee
Unknown (Anonymous)
Other (i.e. Witness, Parent, etc.)
If the caller is a Responsible Employee, what is the Complainant's name (if known)?
Have you verified this name in my.jhu.edu?
Complainant's JHED ID
What is the Complainant's affiliation?
(Required)
Student
Staff
Faculty
Former Affiliate (alumni, former student, staff, faculty, etc.)
Not Affiliated/Unknown
What division is/was the complainant affiliated with?
(Required)
AAP (Advanced Academic Programs)
Academic Centers (i.e. CTY, Berman Institute, JHPIEGO, etc.))
APL (Applied Physics Lab)
BSPH (Bloomberg School of Public Health)
Carey
Engineering for Professionals (EP)
KSAS (Krieger School of Arts and Sciences)
Peabody Institute
SAIS (School of Advanced International Studies)
School of Education
School of Medicine
School of Nursing
University Administration (i.e. Public Safety, Central HR, etc.)
University Student Services
WSE (Whiting School of Engineering)
Non-Affiliate/Not Provided/Unknown
Who is the Complainant's supervisor?
Who is the Complainant's HR representative?
Who is the Complainant's department chair?
What is the Respondent's name (if known)?
Have you verified this name in my.jhu.edu?
Respondent's JHED ID
What conduct is being reported?
(Required)
If the concern is related to a grade, has the complainant appealed their grade through their division?
Yes
No
Is/was the complainant a bargaining unit employee?
Yes
No
If the complainant is/was a bargaining unit employee, have they filed a grievance through their bargaining unit?
Yes
No
Date of Incident(s) (if known)
Location of Incident(s) (if known)
Who conducted the intake call?
(Required)
Luci Summers
Shanika Collick
Other
If "Other," please note who conducted the intake call.
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