Civil Intake Form

Who Can Use This Form: Any individual may use this form to report a concern regarding any member of the NIH community. This includes all federal employees, contractors, trainees/fellows, volunteers, visitors, etc.

Information About Reporting Anonymously

Are there multiple incidents? (optional)
Multiple Incidents
Witnesses
Were There Any Witnesses?(required)

Types of Concerns: Definitions

Harassment:  Unwelcome, deliberate, or repeated unsolicited verbal or physical conduct that is based upon protected classes, including, but not limited to, comments, gestures, graphic materials, physical contact, solicitation of favors, when:

  • Submission to or rejection of the conduct by an individual could be used as the basis for employment decisions affecting the individual; or
  • The conduct is severe or pervasive enough that it substantially interferes with an individual’s work performance or creates a work environment that a reasonable person would consider intimidating, hostile, or abusive.  For the purposes of this policy the “reasonable person” standard considers the employee’s perspective and assesses if a reasonable person exposed to the same or similar circumstances would find the environment hostile, intimidating, or offensive.

Sexual Harassment:  A form of harassment that violates Title VII of the Civil Rights Act of 1964. Unwelcome sexual advances, requests for sexual favors, and other verbal or physical conduct of a sexual nature constitute sexual harassment when this conduct explicitly or implicitly affects an individual's employment, unreasonably interferes with an individual's work performance, or creates an intimidating, hostile, or offensive work environment. 

Inappropriate Conduct:  Any comments or conduct that disparages or demonstrates hostility or aversion towards any person that could reasonably

Bullying: Unwanted, repeated, aggressive behavior that involves a real or perceived power imbalance and intent to harm. The behavior could include, but not be limited to, open or hidden verbal abuse, as well as actions or inactions meant to demean, isolate, or undermine another individual. This may include making statements which are false, malicious, disparaging, derogatory, rude, disrespectful, abusive, or which have the intent to hurt others' reputations.

Threat: Any oral or written expression or gesture that could be interpreted by a reasonable person as conveying intent to cause physical harm to persons or property.

Information About Reporting Anonymously

You may submit a concern without identifying yourself. However, reporting anonymously requires key details about the concern to be omitted, which will limit the NIH’s ability to conduct an inquiry and take corrective action as warranted. Additionally, when the Civil Specialists follow up on anonymous concerns, they cannot guarantee that the reporting party’s identify will remain confidential as it may become apparent throughout the course of the inquiry. 

If you would prefer to discuss all of your options with an office that operates under principles of confidentiality, please contact the Employee Assistance Program or the NIH Office of the Ombudsman.

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