Notice of Occurrence form - Harassment and Violence in the Workplace

Instructions for Principal Party or Witness

Before filling out the form, please review the definition of Workplace Harassment and Violence: The Canada Labour Code defines harassment and violence as: “any action, conduct or comment, including of a sexual nature, that can reasonably be expected to cause offence, humiliation or other physical or psychological injury or illness to an employee, including any prescribed action, conduct or comment.”

You can submit your Notice of Occurrence [PDF – 47 KB] in one of two ways:

• report the occurrence to your supervisor/manager verbally or report it in writing by submitting the Notice of Occurrence form; or
• report the occurrence to the designated recipient verbally by calling 1-833-451-1604 or report it in writing by submitting the Notice of Occurrence form to the following email address: DesignatedRecipientHVP-DestinataireDesignedelaPHV@forces.gc.ca.

Instructions for Supervisor/Manager

If the principal party or witness wants to make a verbal notification, please ask them to provide the information for each of the fields in the Notice of Occurence form. If the witness wishes to remain anonymous, do not record their first and last name. Before you fill out the form, please be sure to read the Definition of Harassment and Violence and the Protection of Privacy sections to the principal party or witness. You will be required to track and report this Notice of Occurrence in accordance with the Policy.

Protection of Privacy and Confidentiality

The information provided in the Notice of an Occurrence form is collected by the Department of National Defence (DND) under the authority of the Public Service Staff Relations Act, Canada Labour Code and the Work Place Harassment and Violence Prevention Regulations.

The information is collected for the purposes of documenting and investigating workplace harassment and violence occurrences in accordance with the employer’s responsibilities.

The information provided in a Notice of an Occurrence will be read by the DND Designated Recipient and employer representative. 

If the resolution process proceeds to conciliation or investigation, a summary of the Notice of Occurrence will be shared with the conciliator and investigator. A summary will also be shared with the responding party, and may be shared with witnesses if the resolution process proceeds to investigation.

The investigator’s report will not include any information, directly or indirectly that may lead to the identification any of the named individuals within an occurrence. The report will be shared with the Designated Recipient or employer representative, principal party, responding party, and the local health and safety committee or health and safety representative.

In limited and specific situations, your personal information may be disclosed without your consent in accordance with subsection 8(2) of the Privacy Act.

Completion of the Notice of an Occurrence is voluntary and any personal information provided will be used and protected in accordance with the Privacy Act, and as described in the Standard Personal Information Bank Harassment – PSE 919.

The Privacy Act provides you the right to request access to and correction of your personal information. For more information about these rights—or about our privacy practices—please contact the DND/CAF Access to Information and Privacy Coordinator. You also have the right to file a complaint with the Privacy Commissioner of Canada regarding our handling of your personal information.

Definitions

Occurrence:

an occurrence of harassment and violence in the work place.

Principal party:

an employee or employer who is the object of an occurrence (formerly known as complainant).

Responding party:

the person who is alleged to have been responsible for the occurrence in the Notice of Occurrence provided under subsection 15(1).

Witness:

a person who witnessed an occurrence or was informed of an occurrence by the principal party or responding party (this could be a supervisor, manager or co-worker).

Designated recipient:

a work unit in a workplace or person designated by an employer to receive notices of occurrence and facilitate the resolution process under the Regulation.

Level One (L1) organization:

A senior official, either civilian or military, who has direct accountability to the Deputy Minister or the Chief of the Defence Staff (i.e. RCN, RCAF, ADM[HR-Civ], ADM[IM]).