PREGNANCY DISCRIMINATION COMPLAINT

EEOC Administrative Charge Template

LEGAL FRAMEWORK UPDATE - 2024

Three Key Federal Laws Now Protect Pregnant Workers:

1. Pregnancy Discrimination Act (PDA) - Prohibits discrimination based on pregnancy, childbirth, or related medical conditions

2. Pregnant Workers Fairness Act (PWFA) - Effective June 27, 2023; Final Regulations June 18, 2024 - Requires reasonable accommodations for limitations related to pregnancy, childbirth, or related medical conditions

3. Americans with Disabilities Act (ADA) - May cover pregnancy-related complications that constitute disabilities

PWFA - Major New Protections

The PWFA requires employers with 15+ employees to provide reasonable accommodations for known limitations related to pregnancy, childbirth, or related medical conditions, unless it would cause undue hardship.

Key PWFA Provisions:
- Applies to pregnancy, childbirth, and "related medical conditions"
- Employer must engage in interactive process
- Accommodations may include modified work schedules, breaks, telework, leave
- Employer cannot require leave if another reasonable accommodation exists
- Cannot retaliate for requesting accommodation

SECTION 1: CHARGE INFORMATION

Charge Presented To:
☐ EEOC (Equal Employment Opportunity Commission)
☐ State/Local FEPA: _____________________________________________________

EEOC Office Location: _________________________________________________

Date of Filing: ________________________________________________________

SECTION 2: COMPLAINANT INFORMATION

Full Legal Name: _____________________________________________________

Street Address: _______________________________________________________

City: _________________________ State: _________ Zip Code: __________

Home Phone: _________________________ Cell Phone: ___________________

Email Address: ________________________________________________________

SECTION 3: EMPLOYER INFORMATION

Company Legal Name: _________________________________________________

Street Address: _______________________________________________________

City: _________________________ State: _________ Zip Code: __________

Phone Number: _______________________________________________________

Number of Employees: _________________________________________________

☐ 15 or more employees (required for Title VII/PDA and PWFA coverage)

SECTION 4: EMPLOYMENT INFORMATION

Job Title: ____________________________________________________________

Department: __________________________________________________________

Date of Hire: _________________________________________________________

Current Status:
☐ Currently Employed
☐ Terminated - Date: _____________________________________________________
☐ Resigned - Date: _______________________________________________________
☐ On Leave - Type: _______________________________________________________

Supervisor Name and Title: _____________________________________________

SECTION 5: PREGNANCY/MEDICAL CONDITION INFORMATION

A. Current or Past Pregnancy

Are you currently pregnant? ☐ Yes ☐ No

If currently pregnant, due date: __________________________________________

If past pregnancy:
- Delivery date: _________________________________________________________
- Type of delivery: ☐ Vaginal ☐ C-Section

Did you experience a pregnancy loss?
☐ Miscarriage - Date: ____________________________________________________
☐ Stillbirth - Date: _______________________________________________________

B. Related Medical Conditions

Check all pregnancy-related conditions that apply:

☐ Morning sickness/Nausea
☐ Gestational diabetes
☐ Preeclampsia/High blood pressure
☐ Hyperemesis gravidarum (severe nausea)
☐ Preterm labor risk
☐ Placenta complications
☐ Bed rest required
☐ Cesarean section recovery
☐ Postpartum depression
☐ Breastfeeding/Lactation
☐ Fertility treatments (IVF, etc.)
☐ Contraception-related condition
☐ Ectopic pregnancy
☐ Endometriosis
☐ Miscarriage recovery
☐ Post-pregnancy complications
☐ Other: ________________________________________________________________

Description of Condition and Limitations:

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

C. When Did Employer Learn of Pregnancy/Condition?

Date employer was informed: ____________________________________________

How was employer informed?
☐ Told supervisor directly
☐ Provided medical documentation
☐ Requested leave/accommodation
☐ Employer observed physical changes
☐ Other: ________________________________________________________________

SECTION 6: TYPE OF DISCRIMINATION CLAIM

Check all that apply:

Pregnancy Discrimination Act (PDA) Claims

☐ I was treated differently because of my pregnancy
☐ I was terminated because I was/am pregnant
☐ I was not hired because I was/am pregnant
☐ I was demoted because of my pregnancy
☐ I was denied a promotion because of my pregnancy
☐ My job duties were unfavorably changed due to pregnancy
☐ I was harassed because of my pregnancy
☐ I was forced to take leave when I could still work
☐ I was not treated the same as other employees with similar limitations
☐ I was retaliated against for complaining about pregnancy discrimination

Pregnant Workers Fairness Act (PWFA) Claims

☐ I was denied a reasonable accommodation for my pregnancy-related limitation
☐ Employer refused to engage in the interactive process
☐ Employer required me to take leave when another accommodation was available
☐ Employer required me to accept an accommodation I did not want
☐ Employer retaliated against me for requesting an accommodation
☐ Employer took adverse action because I need accommodation in the future

Breastfeeding/Lactation Claims

☐ I was denied break time to express milk
☐ I was not provided an appropriate space to express milk
☐ I was discriminated against for breastfeeding/pumping
☐ I was retaliated against for requesting lactation accommodations

FMLA-Related Claims (Note: FMLA claims filed with DOL, not EEOC)

☐ I was denied FMLA leave for pregnancy/childbirth
☐ I was retaliated against for taking FMLA leave
☐ My position was not held/restored after FMLA leave

SECTION 7: REASONABLE ACCOMMODATION REQUEST (PWFA)

A. Did You Request an Accommodation?

☐ Yes ☐ No

If yes:

Date of Request: ______________________________________________________

To Whom Did You Make the Request?

Name: __________________________________________________________________

Title: ___________________________________________________________________

What Accommodation Did You Request?

☐ More frequent breaks
☐ Break time to eat and drink
☐ Break time for restroom use
☐ Permission to sit (if job requires standing)
☐ Permission to stand (if job requires sitting)
☐ Modified work schedule
☐ Telework/Work from home
☐ Temporary transfer to less strenuous position
☐ Light duty assignment
☐ Temporary suspension of certain job duties
☐ Leave for medical appointments
☐ Leave for recovery from childbirth
☐ Time and space for lactation
☐ Lifting limitations: _____________________________________________________
☐ Other: ________________________________________________________________

Detailed Description of Accommodation Requested:

___________________________________________________________________________

___________________________________________________________________________

B. Employer's Response

Did the employer engage in the interactive process? ☐ Yes ☐ No ☐ Partially

Employer's Decision:
☐ Accommodation granted as requested
☐ Alternative accommodation offered
☐ Accommodation denied
☐ Forced to take leave instead
☐ No response

Date of Decision: _____________________________________________________

Reason Given for Denial (if applicable):

☐ Claimed undue hardship
☐ Said accommodation not necessary
☐ Said I should take leave instead
☐ No reason given
☐ Other: ________________________________________________________________

Did you provide medical documentation? ☐ Yes ☐ No

If yes, what documentation? _______________________________________________

SECTION 8: ADVERSE EMPLOYMENT ACTION

A. What Happened?

Date of Adverse Action: ________________________________________________

Type of Adverse Action:

☐ Termination/Discharge
☐ Demotion
☐ Denial of promotion
☐ Reduction in pay
☐ Reduction in hours
☐ Unfavorable schedule change
☐ Denial of job opportunity
☐ Negative performance evaluation
☐ Discipline/Written warning
☐ Forced to take leave
☐ Denied return from leave
☐ Position eliminated while on leave
☐ Harassment/Hostile work environment
☐ Constructive discharge (forced to quit)
☐ Other: ________________________________________________________________

B. Details of Adverse Action

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

C. Employer's Stated Reason

What reason, if any, did the employer give?

___________________________________________________________________________

___________________________________________________________________________

Why do you believe this reason is pretextual (false)?

___________________________________________________________________________

___________________________________________________________________________

SECTION 9: COMPARATIVE TREATMENT

A. Treatment of Non-Pregnant Employees with Similar Limitations

The PDA requires that pregnant employees be treated the same as other employees who are similar in their ability or inability to work.

Were non-pregnant employees with similar limitations treated differently?
☐ Yes ☐ No ☐ Unknown

If yes, describe:

B. Light Duty Policy

Does the employer provide light duty for:

☐ Work-related injuries - Describe: _________________________________________

☐ Non-work-related injuries - Describe: _____________________________________

Were you denied light duty that is provided to others? ☐ Yes ☐ No

SECTION 10: DETAILED STATEMENT OF FACTS

Describe what happened in chronological order. Include WHO, WHAT, WHEN, WHERE.

A. Timeline of Events

B. Narrative Description

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

C. Statements Made Regarding Pregnancy

Document any statements by managers, supervisors, or coworkers about your pregnancy:

SECTION 11: RETALIATION

Did you experience retaliation for:

☐ Informing employer of pregnancy
☐ Requesting a pregnancy-related accommodation
☐ Complaining about pregnancy discrimination
☐ Taking pregnancy-related leave
☐ Filing an EEOC charge
☐ Other protected activity: ________________________________________________

Describe the retaliation:

___________________________________________________________________________

___________________________________________________________________________

SECTION 12: STATE-SPECIFIC NOTES

California

• State Law: California FEHA, Government Code § 12940 et seq.
• Pregnancy Disability Leave: Up to 4 months for pregnancy disability
• Additional Requirements: Employers must provide reasonable accommodation for pregnancy
• Lactation: Strong protections for lactation breaks and space
• Filing Deadline: 3 years to file with CRD
• CFRA: California Family Rights Act provides additional leave protections

Texas

• State Law: Texas Labor Code Chapter 21
• State Filing: 180 days to file with TWC-CRD
• Note: Federal PWFA provides significant new protections

Florida

• State Law: Florida Civil Rights Act
• State Filing: 365 days to file with FCHR
• Note: Federal PWFA provides significant new protections

New York

• State Law: New York State Human Rights Law
• Stronger Protections: NY provides broader pregnancy accommodation requirements
• Paid Family Leave: NY provides paid leave for baby bonding
• Filing Deadline: 3 years to file with DHR (as of 2/15/2024)
• NYC: NYC Pregnant Workers Fairness Act (local law) provides additional protections

SECTION 13: WITNESSES

SECTION 14: EVIDENCE

Documents You Have:

☐ Medical documentation of pregnancy/condition
☐ Accommodation request (written)
☐ Employer's response to accommodation request
☐ Termination letter
☐ Performance evaluations
☐ Emails/Correspondence about pregnancy
☐ Witness statements
☐ Leave request documentation
☐ FMLA paperwork
☐ Company policies (accommodation, leave, light duty)
☐ Other: ________________________________________________________________

SECTION 15: DAMAGES

Economic Damages

Lost Wages: $ _________________________________________________________

Lost Benefits: $ _______________________________________________________

Medical Expenses: $ ____________________________________________________

Other Economic Losses: $ _______________________________________________

Non-Economic Damages

Emotional Distress:

___________________________________________________________________________

___________________________________________________________________________

☐ I have sought medical or mental health treatment

SECTION 16: RELIEF REQUESTED

☐ Back pay and lost benefits
☐ Front pay
☐ Reinstatement
☐ Reasonable accommodation
☐ Compensatory damages for emotional distress
☐ Punitive damages
☐ Attorney's fees and costs
☐ Policy changes at employer
☐ Training for management
☐ Removal of negative information from personnel file
☐ Other: ________________________________________________________________

SECTION 17: FILING DEADLINES

SECTION 18: VERIFICATION AND SIGNATURE

I declare under penalty of perjury that the information provided in this charge is true and correct to the best of my knowledge, information, and belief.

I understand that:
- Pregnancy discrimination is illegal under federal and state laws
- The PWFA requires reasonable accommodations for pregnancy-related limitations
- I must cooperate with the EEOC investigation
- Filing this charge protects my right to file a lawsuit if necessary

Signature: ____________________________________________________________

Printed Name: _________________________________________________________

Date: ________________________________________________________________

ATTACHMENT CHECKLIST

☐ Medical documentation (if applicable)
☐ Accommodation request documentation
☐ Employer's response to accommodation request
☐ Performance evaluations
☐ Termination documentation
☐ Emails/correspondence about pregnancy
☐ Company policies
☐ Witness contact information
☐ Additional pages for detailed statement

PWFA QUICK REFERENCE

Examples of Reasonable Accommodations Under PWFA

• Additional, longer, or more flexible breaks
• Seating or standing options
• Schedule changes
• Remote work
• Job restructuring
• Light duty
• Leave for medical appointments
• Leave to recover from childbirth
• Lactation breaks and space
• Temporary transfer
• Excusing from strenuous activities
• Providing closer parking

What Employers Cannot Do Under PWFA

• Require employee to accept an accommodation without discussion
• Deny employment opportunity based on need for accommodation
• Require leave if another reasonable accommodation exists
• Retaliate against employee for requesting or using accommodation
• Interfere with any rights under PWFA

Pregnancy discrimination protections have been significantly strengthened with the PWFA. Document all accommodation requests and employer responses carefully. Consult with an employment attorney to understand your full rights.