|Please return this form to the commission. If you prefer to mail it
to us our address is:
The Pullman Human Rights Commission
Incident Reporting Form (Please print)
Nature of Complaint/Report
___ Personal (involves an individual)Type of Complaint/Report
Please describe the incident. (attach separate
sheets of paper if neccessary)
Resolution of Complaint/Report
Please check an appropriate category:
Prior to contacting the Pullman Human Rights Commission,
(please check an appropriate category)
___ I contacted area law enforcement.
___ I reported this incident by calling 332-BIAS.
___ I filed for grievances through institutional procedures.
___ I filed a complaint to another agent. Please describe:______________________
___ I have not told anyone about this report.
What would you consider an appropriate solution to
your complaint? (attach additional sheets if necessary)
PHRCís Response to Case Number:_________________________________________________
Date Received:______________________________ Date Completed:_____________________
Person filing the report wanted to meet with the PHRC.
PRHC met with the person on this date ______________
PRHC members present at the meeting:
Complainantís Report/Issues Discussed:
Action Taken by PHRC:
PHRC assisted in contacting appropriate agency about this issue.
Agency/Agencies Contacted: (when & who)
The person filing this report indicated the following desired solution
to the issue:
PHRC summary & final resolution of this case: (attach
additional sheets if necessary)