D.C. Private Employment Discrimination Complaint Preparation Worksheet - District of Columbia
D.C. PRIVATE EMPLOYMENT DISCRIMINATION COMPLAINT PREPARATION WORKSHEET
Before you use this: This worksheet is for an employee, applicant, or worker in private employment in the District. For a District government employment claim, OHR's EEO counseling instructions generally require contacting an agency EEO counselor within 180 calendar days of the act or its discovery, then filing a formal OHR complaint within 15 calendar days after receiving the counselor's Exit Letter. OHR says counseling is not required for sexual-harassment or DCFMLA claims. Use the current Employment intake questionnaire to file with OHR; this worksheet itself is not a filing. D.C. Code § 2-1403.04(a) generally requires an Office complaint within one year after the unlawful practice occurred or was discovered, subject to the modification referenced there. Contact the Office promptly if the date is close.
People and work
Your full name and private contact information: [________________________________]
Employer's full name and address: [________________________________]
District worksite and your position or application: [________________________________]
Relevant work dates and decision makers: [________________________________]
Particulars for the Office's questionnaire
D.C. Code § 2-1403.04(a) calls for the respondent's name and address and the substance of the complaint. Give enough detail for the Office to identify what occurred and when.
| Date | Event or decision | Person involved | Record or witness |
|---|---|---|---|
| [__/__/____] | [FACTS] | [NAME AND ROLE] | [RECORD OR WITNESS] |
| [__/__/____] | [FACTS] | [NAME AND ROLE] | [RECORD OR WITNESS] |
Date of the alleged practice: [__/__/____]
Date you discovered it, if different: [__/__/____]
Protected trait or legally protected activity identified in the Office's Employment questionnaire: [________________________________]
Facts connecting the decision to that trait or activity:
[____________________________________________________________]
Reason the employer gave, if any: [________________________________]
Other specific facts the Office should know: [________________________________]
What resolution do you request the Office to consider? [________________________________]
Filing record
☐ Transfer your facts to the Office's current Employment intake questionnaire and submit the completed official form through one of the Office's listed methods. An email without the complaint form is not accepted.
☐ Keep a copy and proof of delivery, and ask the Office to confirm when it received the complaint.
Official form sent: [__/__/____] Office receipt confirmed: [__/__/____]
Confirmation or reference number: [________________________________]
Official sources
About this template
- Last updated
- November 4, 2026
- Citations checked
- November 4, 2026
- Jurisdiction
- District of Columbia
- Category
- Employment & HR
Legal authority
- D.C. Code § 2-1403.04(a)
- D.C. Office of Human Rights, File a Discrimination Complaint
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 November 4, 2026.
D.C. Code § 2-1403.04(a) (checked November 4, 2026): "The complaint shall state the name and address of the person alleged to have committed the violation, hereinafter called the respondent, and shall set forth the substance thereof, and such other information as may be required by the Office."
D.C. Code § 2-1403.04(a) (checked November 4, 2026): "Any complaint under this chapter shall be filed with the Office within 1 year of the occurrence of the unlawful discriminatory practice, or the discovery thereof, except as may be modified in accordance with § 2-1403.03 ."
D.C. Office of Human Rights, File a Discrimination Complaint (checked November 4, 2026): "To file a complaint with the Office of Human Rights (OHR), simply complete an intake questionnaire and submit it to OHR."
D.C. Office of Human Rights, File a Discrimination Complaint (checked November 4, 2026): "sending an email without a complaint form will not be accepted."
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