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Bias, Discrimination and Harassment Reporting Form


Diversity, Inclusion and Community Engagement Blueprint for Action Statement:
The University holds itself accountable, at every level of the organization, to nurture an environment of inclusion and respect, by valuing the uniqueness of every individual, celebrating and reflecting the rich diversity of its communities, and taking meaningful action to cultivate an environment of fairness, belonging & opportunity.

Our Commitment to You:
Thomas Jefferson University is committed to fostering a safe and welcoming campus community. In turn, it is the responsibility of each person within the University community to join in creating an environment in which others have a positive experience and promote inclusion and respect.

If you need to report an emergency or are reporting an incident that poses an imminent risk of harm, contact the Department Public Safety at:
East Falls: 215-951-2999,
Center City: 215-955-8888 (Campus Phone 811),
Or dial 9-1-1.
Please Note
: that completing this report does not substitute for contacting the police.

Reporting Bias, Discrimination and Harassment:
This incident report form is available to anyone who would like to notify the University about the following involving a TJU student:
Bias, Discrimination and Harassment, as defined below, is prohibited. Retaliation against an individual who has made a good faith complaint is prohibited.

1. Bias incidents include conduct or behavior (verbal, nonverbal, or written) that is threatening, harassing, discriminatory, and is grounded on any characteristic protected by law including but not limited to a person’s sex, age, race, color, religion, sexual orientation, gender identity, gender expression, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, disability or any other protected group or status.

2. Discrimination, under this policy, is conduct that is grounded on any characteristic protected by law including but not limited to a person’s sex, age, race, color, religion, sexual orientation, gender identity, gender expression, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, disability or any other protected group or status; or is used as the basis for or a factor in decisions affecting that individual’s working, education, living environment or participation in a University activity.

3. Harassment is unwelcome verbal, written, electronic, or physical conduct when that conduct is grounded on any characteristic protected by law including but not limited to a person’s sex, age, race, color, religion, sexual orientation, gender identity, gender expression, marital status, pregnancy, national origin, ancestry, citizenship, military status, veteran status, disability or any other protected group or status; and such conduct has the purpose or effect of unreasonably interfering with an individual’s work or academic performance by creating an intimidating, hostile, humiliating, demeaning, or offensive employment, academic or social environment.

When should I report?

  • The sooner you report an incident, the greater likelihood that you will remember important information and details.

What information should I include in the incident report?

  • You will likely be asked to recall the following information, but don’t let the absence of such information deter you from reporting.
  • A detailed account of the incident: who, what, where, how, and why. Include words that were spoken, gestures, and other behavior.
  • The names, descriptions, and contact information of those involved, including witnesses.
  • Any other relevant information such as photos, screen shots, communications, etc.

Who will investigate a report of a possible bias, discrimination or harassment incident?

  • Once a report is received, it will be assigned to the Dean of Student’s Office for the East Falls Campus or the Assistant Provost for Diversity and Inclusion’s Office for the Center City Campus.
  • Once assigned, a staff member from the office will reach out to the complainant to gather further information within two (2) business days of receiving the complaint.
  • If through information gathering the staff member determines that a crime may have occurred the incident will be referred to Public Safety. Reports of possible hate crimes are investigated by Public Safety. If Public Safety determines there is no crime involved in the reported incident, they will refer the incident to the appropriate University office for further processing.
  • If the reported bias incident is determined to implicate the University Community Standards or the Employee Code of Conduct, the incident will be referred to the Dean of Students Office/Assistant Provost’s Office (students) or the Office of Human Resources (employees) for further processing.
  • University offices receiving reports consider privacy and due process rights of those involved.

 


Please Note: that this form may not be reviewed outside of normal business hours.

Additional Reporting Options:

To report a violation of the Academic Integrity Policy, use the Academic Integrity Reporting form.

To report a Behavioral Concern, use the Jefferson Behavioral Intervention Report form.

To report Sex and Gender-Based Misconduct, use the Sex and Gender-Based Misconduct form.

To report a potential violation of the University Community Standards, use the General Incident Reporting Form.

Background Information of the Person Submitting this Report

Q: Do I have to provide my name?


A: No. You may report anonymously. You may also provide your name now and later request to the Community Standards Officer that your identifying information be kept private.


Please Note: while you may submit this information anonymously, the University’s response may be limited. Without your contact information, we will not have the ability to follow up with you to obtain any other information needed or connect you to resources.

Email address must be of a valid format.
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You college/school affiliation within TJU
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Involved Parties

Please include any known contact information for the individuals involved in the incident (do not include yourself).

Involved party 1

Incident Information

Please indicate the relevant sections that pertain to this incident report.

Please select the type of incident that you are reporting. For definitions of Bias, Discrimination and Harassment refer to the instructions at beginning of the form.(Required)
You must make at least one selection.
Please select the protected categories that have been allegedly violated.(Required)
You must make at least one selection.
This field is required.
Were any University officials present at or contacted about this incident?(Required)
You must make at least one selection.
This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission