
Iling Address: Home or Cell Phone #: Street Address City (Area Code) State Zip Name of Warden or Department Head: Email Address: Respondent Information (Person Complained Against) Name: Title: Date(s) of Discriminatory Event: Are you complaining about: Unit or Dept: Earliest: Latest: Slurs or Hostile Epithets? (Check) Yes No If yes, explain: Color Discrimination? Yes No If yes, identify your color: Race Discrimination? Yes No If yes, identify your race: National Origin Dis.
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How to fill out the TX PERS 497 online
Filling out the TX PERS 497 form is a crucial step in addressing any concerns related to discriminatory events in the workplace. This guide will provide clear and supportive instructions on how to complete the form online, ensuring that your complaint is accurately represented.
Follow the steps to effectively fill out the TX PERS 497 form online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin with the complainant information section. Enter your name, payee ID, title, unit or department, work shift, and schedule card. Additionally, provide your home mailing address, phone number, email address, and the name of your warden or department head.
- Proceed to the respondent information section. Fill in the name and title of the individual you are complaining against, along with the specific dates of the discriminatory event. You must indicate the relevant unit or department and whether or not slurs or hostile epithets were used.
- Answer the questions regarding discrimination types such as color, race, national origin, gender, sexual harassment, age, disability, EEO retaliation, genetic information, and religion. For each type of discrimination applicable to your complaint, provide the necessary identification details.
- In the statement section, provide detailed accounts of the events you are complaining about. Include specifics such as who was involved, what happened, when it took place, and where it occurred. Attach additional pages if needed, ensuring they are properly numbered, signed, and dated.
- List all known witnesses and summarize what they may testify about regarding the alleged events. Also, document the names of individuals to whom you reported the incidents and the dates of those reports.
- After completing all sections, review your responses for accuracy. To finalize, you will need to sign and date the complaint statement. Make sure to attach any additional pages as required.
- Once all information is completed and verified, you can save changes, download, print, or share the form as necessary.
Begin completing your TX PERS 497 form online today to ensure your concerns are formally documented.
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The Office of the Ombudsman works independently as an intermediary to provide individuals with a confidential avenue to address complaints and resolve issues at the lowest possible level. The Office proposes policy and procedural changes when systemic issues are identified.
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