Employment Discrimination Interview Evaluation Form
Please complete the Employment Discrimination Interview Evaluation Form to document the interview, assess relevant factors, and provide your recommendation.
Interviewer Name
*
First Name
Last Name
Date of Interview
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Interviewee Role/Department
*
Incident Summary (describe the alleged discrimination incident)
*
Witnesses or Other Relevant Context
Assessment of Incident Details
*
Rows
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The interviewee provided clear details
1
2
3
4
5
The incident described aligns with discrimination definitions
6
7
8
9
10
Supporting evidence was presented
11
12
13
14
15
The interviewee was credible
16
17
18
19
20
Overall Severity of Incident
*
1
2
3
4
5
Recommendation / Outcome
*
Further Investigation Recommended
No Further Action
Referral to HR
Other
Additional Comments
Submit Evaluation
Should be Empty: