Form

Bullying, Harassment and Discrimination Notification Form

Effective: January 2023

This form is for reporting any occurrences of bullying, discrimination or sexual harassment within the AMA (WA) workplace, including work-related meetings and events.

This form does not constitute a formal complaint. If you want to make a formal complaint, please complete the Discrimination / Harassment / Bullying Incidents Complaints Form.

Sexual harassment of a type that is criminal conduct by nature (e.g. physical molestation, sexual assault, indecent exposure, stalking, obscene communications) should also be reported to the Police.

Name (if you do not wish to provide your name write "Anonymous") *

Name of person(s) who has or is conducting the behaviour you are reporting.

Date of report *

Nominate a classification that best represents the person(s) you are reporting. *

AMA (WA) Employee

AMA (WA) Board member

AMA (WA) Committee

Please describe the conduct you wish to report, including when and where the conduct occurred and what was said or done. If the conduct occurred on more than one occasion, describe the frequency and for how long the conduct has been occurring. *

Were there any witnesses to the conduct? *

Yes