Discrimination Complaint

Mary Hao, Director, Human Resources
Instructions Here:

Discrimination Complaint Form


Part I - HARASSMENT: Harassment is unwelcome verbal, physical, visual, written or environmental misconduct based on a Protected Class, which is offensive to a reasonable person in like or similar circumstances. Prohibited harassment can consist of virtually any form or combination of verbal, physical, visual/written or environmental conduct. It need not be explicit, or even specifically directed at the victim.

Part II - DISCRIMINATION: In conformance with the Board policy to provide a workplace free from discrimination and to provide for equal employment opportunities, barring any lawful or valid reasons, all employees and applicants will have equal access to County operations and employment regardless of their actual or perceived status in a Protected Class.

Part III - RETALIATION: Retaliation is defined as any adverse employment action which is reasonably likely to prevent the complaining party or others from engaging in opposition to employment practices that violate the County’s equal employment or anti-harassment policies. An adverse employment action could include but is not limited to a decrease in pay, change of hours, or reduction in authority and responsibility. Retaliation for filing a complaint about, or participating in, a PMR 21 investigation is also a violation of this policy and will not be tolerated.

Form Submission: Forms must be submitted to the Director of Human Resources and must be filed within one hundred and fifty (150) days of the alleged violation.

Cover Sheet: Complainant Information
Employment Status (required)
Complaint types being filed:

Part I - Harassment
2. Protected categories (Check all that apply to this incident):

Part II - Discrimination
2. Check all protected categories below that apply to the incident:

If you are not a current Marin County employee, were you (select one):

Part III - Retaliation
2. Check all conduct that you engaged in:

By checking this box I certify that all of the statements made in this complaint are true and correct to the best of my knowledge and belief. (required)