New Hampshire Employment Discrimination Charge Preparation Worksheet
NEW HAMPSHIRE EMPLOYMENT DISCRIMINATION CHARGE PREPARATION WORKSHEET
Before you use this: A New Hampshire Commission for Human Rights employment intake inquiry is not a filed Charge of Discrimination. The Commission explains that a charge becomes formal only after it receives a notarized charge form and dockets the case. Under RSA 354-A:21(III), an aggrieved person's complaint ordinarily must be filed within 180 days after the alleged act of discrimination. Contact the Commission promptly at (603) 271-2767 or [email protected], especially if the date may be close. The Commission's Submit a Complaint page gives the current intake route and deadline guidance.
This worksheet helps you prepare a clear timeline for the Commission's Employment Intake Questionnaire. Do not send this worksheet in place of the Commission's intake submission or formal charge.
1. IDENTIFY THE PEOPLE AND WORKPLACE
Your name: [________________________________]
Phone, email, and mailing address: [________________________________]
Employer or employment agency name and address: [________________________________]
Your job, application, or other employment relationship: [________________________________]
Person or people involved, with job titles if known: [________________________________]
Employment dates, if relevant: [________________________________]
2. BUILD A DATED TIMELINE
The Commission asks intake submissions to explain what happened, when, who was responsible, and how the events relate to a protected characteristic. Give specific events rather than a general statement that details are available on request.
| Date | Event or decision | Person involved | Record or witness |
|---|---|---|---|
| [__/__/____] | [WHAT HAPPENED] | [NAME AND ROLE] | [EMAIL, DOCUMENT, OR WITNESS] |
| [__/__/____] | [WHAT HAPPENED] | [NAME AND ROLE] | [EMAIL, DOCUMENT, OR WITNESS] |
| [__/__/____] | [WHAT HAPPENED] | [NAME AND ROLE] | [EMAIL, DOCUMENT, OR WITNESS] |
Date of the most recent event you want the Commission to consider: [__/__/____]
Describe the treatment you received and, if you know, how similarly situated people were treated differently. State what you observed and what supports your belief about the reason for the treatment.
[____________________________________________________________]
[____________________________________________________________]
Protected characteristic or other legal basis you believe is involved: [________________________________]
Explain the connection between that basis and each event, using facts rather than a conclusion alone:
[____________________________________________________________]
[____________________________________________________________]
What documents, messages, policies, or witnesses support your account? [________________________________]
3. RECORD PRIOR ACTION AND REQUESTED HELP
Have you raised this concern with the employer or another agency? Give dates, contacts, and responses.
[____________________________________________________________]
[____________________________________________________________]
What outcome are you asking the Commission to consider? [________________________________]
4. USE THE COMMISSION'S PROCESS
☐ Review the Commission's submission instructions and complete its current Employment Intake Questionnaire or other route it directs.
☐ If the Commission sends a draft charge, check the names, dates, employer, and allegations carefully and ask how to correct any error.
☐ Follow the Commission's directions for the formal sworn and notarized charge. An intake questionnaire alone does not complete that step.
☐ Keep copies and record when the Commission confirms receipt and dockets the formal charge.
Intake date: [__/__/____] Formal charge docket date, if confirmed: [__/__/____]
If you are an attorney seeking an EEOC Form 5 or State Charge Form, the Commission's submission page directs attorneys to contact [email protected].
Official sources
About this template
- Last updated
- October 27, 2026
- Citations checked
- October 27, 2026
- Jurisdiction
- New Hampshire
- Category
- Employment & HR
Legal authority
- N.H. Rev. Stat. Ann. § 354-A:21(I)(a), (III)
- New Hampshire Commission for Human Rights, Employment Intake Questionnaire
Employment documents govern the relationship between a company and its workers, from offer letters and employment agreements through handbooks, performance reviews, and separations. Done right, they set clear expectations, protect against wrongful termination and discrimination claims, and give both sides a record to rely on. Done poorly, they invite lawsuits, agency complaints, and costly disputes.
Not legal advice
This template is provided for informational purposes. We recommend having an attorney review any legal document before signing, especially for high-value or complex matters.
Checked against the law it cites
A reviewer verified this template's legal citations against the official source on October 27, 2026.
N.H. Rev. Stat. Ann. § 354-A:21(I)(a), (III) (checked October 27, 2026): "Any complaint filed pursuant to this section by an aggrieved person must be filed within 180 days after the alleged act of discrimination."
New Hampshire Commission for Human Rights, Employment Intake Questionnaire (checked October 27, 2026): "Until the notarized charge form is received and the case is docketed, your submission remains classified as an intake inquiry, not a formal charge."
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