South Dakota Employment Discrimination Charge Intake Preparation Worksheet

SOUTH DAKOTA EMPLOYMENT DISCRIMINATION CHARGE INTAKE PREPARATION WORKSHEET

Before you use this: The South Dakota Division of Human Rights directs employment complainants to complete, sign, and submit its official Charging Party Intake Form. Its charge guide says the intake form is not the charge. The Division reviews the intake and drafts a formal charge for your approval; the formal charge must be signed before a notary. For a South Dakota Human Relations Act charge, § 20-13-31 gives 180 days after the alleged practice. Plan for the Division to receive the notarized charge in time; submitting this worksheet or the intake alone does not satisfy that step.

1. Charging party and employer

Your name: [________________________________]

Your preferred mailing address: [________________________________]

Phone and email: [________________________________]

Employer's legal name: [________________________________]

Employer's workplace address: [________________________________]

Employer's mailing address, if different: [________________________________]

Human resources or supervisor contact, if known: [________________________________]

Your job title and employment dates: [________________________________]

2. What happened and why you believe it was discriminatory

Identify any South Dakota employment ground you believe applies under § 20-13-10:

☐ Race ☐ Color ☐ Creed ☐ Religion ☐ Sex ☐ Ancestry ☐ Disability ☐ National origin

Employment action involved: ☐ Application or hiring ☐ Training or apprenticeship ☐ Promotion or upgrading ☐ Compensation ☐ Layoff or discharge ☐ Other term or condition [________________________________]

Most recent date of an alleged discriminatory action: [__/__/____]

Earlier related dates, if any: [________________________________]

Describe each action with a date, the person involved, what was said or done, and its effect on your work:

Employer's explanation, if given: [________________________________]

Other facts supporting your account, including how similarly situated people were treated, if known: [________________________________]

3. Evidence and witnesses

People who saw, heard, or have records of relevant events, with safe contact details: [________________________________]

Records to gather: ☐ job posting or application ☐ personnel records ☐ pay records ☐ evaluation or discipline ☐ messages ☐ accommodation request and response ☐ other [________________________________]

Where each record can be found and what it shows: [________________________________]

Earlier report to a supervisor or another agency, if any, with date and response: [________________________________]

4. Filing steps to complete on the Division's form

☐ Open the current employment Charging Party Intake Form through the Division's forms page, transfer accurate facts from this worksheet, sign, and submit it as instructed there.

☐ If disability is involved, check the forms page and the Division's instructions for any additional questionnaire.

☐ Record when the Division receives the intake and how to contact the assigned representative: [________________________________]

☐ Review the Division-drafted Charge of Discrimination for accuracy. Request corrections before signing if needed.

☐ Sign the charge before a notary and return it so the Division receives it within the applicable filing period. Record the return method, date, and receipt: [________________________________]

This worksheet is for your preparation. Keep a copy of the intake, formal charge, submission proof, and records; do not send this worksheet in place of the Division's forms.

Official sources

• S.D. Codified Laws §§ 20-13-10, 20-13-29, 20-13-31
• Division of Human Rights forms
• Division of Human Rights charge guide