The Complaint Form

• Complete this form to file a complaint. Part I of the form is for basic information,
  Part II is for details. Contact the Commission for more information or for help.
• The Human Rights Commission will use the information on this form to investigate your complaint.
• If you move, please call the Commission with your new address. If you do not tell us your new address, your complaint may be dismissed.
• Do you need this document in another language, large print, audio, or e-mail? Contact the Commission.

Part I – Basic Information

1) Who experienced the discrimination?

Name: __________________________________________
Mail address: __________________________________________
Home phone: __________________________________________
Work phone: __________________________________________

2) What person or group discriminated against you?

Name: __________________________________________
Mail address: __________________________________________
Telephone: __________________________________________
Fax: __________________________________________

3) How were you discriminated against? Check all that apply.

__ Race
__ Colour
__ Ancestry
__ Ethnic origin
__ Place of origin
__ Nationality
__ Creed
__ Religion
__ Disability
__ Sex
__ Pardoned criminal record
__ Marital status
__ Gender identity
__ Age
__ Social condition
__ Family status
__ Family affiliation
__ Political belief
__ Political association
__ Sexual Orientation

4) Where did the discrimination take place? Check all that apply.

__ Work or looking for work
__ Renting a home or workspace
__ Joining a trade union or professional group
__ Public services like stores, offices, schools, health services
__ Printed things such as newspapers, pamphlets, magazines

5) When did the discrimination happen?

Just write down the date of the discrimination or the date of the last incident of discrimination.

Part II - Details about your complaint

How to fill out Part II

• Start at the beginning. List each time you were discriminated against. When did it happen? Who was involved? Where did it happen? What happened? Use point form. Include all the dates.
• Give details. What did people say or do that was discriminating? Try to write exactly what people said or did. What did you say or do to respond? Use quotation marks to show when the words are “exactly what a person said”.
• Why do you think this person or agency discriminated against you?
• Include copies of documents that relate to your complaint. These could be letters, a record of employment, rental agreements, medical papers, or other papers.
• Sign your complaint and date it on the bottom of the last page.
• If your complaint is about race, colour, ancestry, nationality, ethnic origin, or birthplace, tell us about your background. Say how it’s connected to the complaint.
• If your complaint is about religion, faith, or spiritual beliefs, tell us about your religion or beliefs. Say how it’s connected to the complaint.
• If your complaint is about disability, tell us about your disability. Say how it’s connected to the complaint.
• If your complaint is about age, tell us your birth date.
• If you quit your job or were fired, tell us the names of people who talked to you about it.
• If you didn’t get public services when you asked for them, tell us who is involved and where this happened.
• If someone refused to rent you an apartment or business space, tell us who is involved and where this happened.

Your name: __________________________________________

This complaint is against: ___________________________________

Use point form. Use more pages in necessary.

Date	Who was involved? What happened? Where did it happen?

Your signature ___________________________________

Date ___________________________________

 

The Complaint Guide

What is a human rights complaint?

The Human Rights Act says we may file a complaint if we believe a person or agency broke the law and discriminated against us. The complainant is the person who files the complaint. The respondent is the person or agency the complainant believes discriminated against them.

How does the complaint process work?

There are 5 possible steps:

1) The complainant fills out the complaint form and sends it to the Human Rights Commission.

2) The Human Rights Commission reviews the complaint. They need to make sure the Human Rights Act covers the discrimination. If it does, the complaint will proceed. If it doesn’t, the complaint stops here.

If the complaint goes ahead, the Commission contacts the respondent. The respondent gets a copy of the complaint.

3) The Commission may appoint a mediator. The mediator’s job is to discuss the complaint with the complainant and the respondent, and to look for solutions. The complainant and the respondent may each bring a support person to mediation meetings. The support person might be a friend, relative, lawyer, or other advocate.

People share information during mediation. It is confidential. If the complainant and respondent agree on a solution, the complaint ends here. If they don’t, the complaint moves to the next step.

4) The Commission investigates the complaint if mediation doesn’t work. The reason they investigate is to get more information about both sides of the story. The investigator interviews witnesses and gathers information.

The investigator writes a report about what they find out. The complainant and the respondent read the investigator’s report. They can respond to the report before the Commission decides to dismiss the complaint or have a hearing.

5) If there is a hearing, an adjudicator oversees the hearing. The adjudicator listens to the complainant, the respondent, and witnesses. The adjudicator decides if the respondent broke the law. If they didn’t, the adjudicator dismisses the complaint.

If the respondent broke the law, the adjudicator may order them to stop the discrimination. They may also order the respondent to pay the complainant for lost wages, benefits or hurt feelings.

How long does the complaint process take?

The complaint process can last 2 to 12 months. It will take less time if mediation settles the complaint and more time if there is a hearing or a lot of information and witnesses.

What other rules does the complaint process have?

1. A complaint must be filed within 2 years from when the discrimination happened.
2. The person who filed the complaint may withdraw it any time.
3. The complaint must be about discrimination in the NWT.
4. No one pays money to the Commission to file a complaint.
5. The complainant can’t be fired, evicted, expelled, or punished in any way because of the complaint.
6. The complainant can appeal a decision to dismiss the complaint. The complainant or the respondent can ask the NWT Supreme Court to review the Commission’s decision.

Do you need this document in another language, large print, audio, or e-mail?
Contact the Commission :

PO Box 1860
Yellowknife, NT X1A 2P4
Toll Free: 1-888-669-5575
Yellowknife: 867-669-5575
Fax: 867-873-0357
E-mail: info@nwthumanrights.ca
Web:www.nwthumanrights.ca