Human Rights Complaint
Form and Guide
IMPORTANT: NOTE TO COMPLAINANTS
If you download and print the Contact Information Form
and the Complaint Form, which are found at the back of this
document, please print one-sided and print or type only on
the printed side of the forms. The back sides of all pages of
the forms should be left blank.
The Commission will make this publication available in an
accessible format upon request for people with disabilities
who do not read conventional print.
MARCH 2017
Contact the Alberta Human Rights Commission
Northern Regional Office
800-10405 Jasper Avenue NW
Edmonton, Alberta T5J 4R7
Confidential Inquiry Line 780-427-7661
Fax 780-427-6013
Southern Regional Office
200 J.J. Bowlen Building
620 - 7 Avenue SW
Calgary, Alberta T2P 0Y8
Confidential Inquiry Line 403-297-6571
Fax 403-297-6567
To call toll-free within Alberta, dial 310-0000 and then enter the area code and
phone number.
TTY service for persons who are deaf or hard of hearing
Toll-free within Alberta 1-800-232-7215
E-mail [email protected]
Website albertahumanrights.ab.ca
The Alberta Human Rights Commission is an independent commission of
the Government of Alberta. Our mandate is to foster equality and reduce
discrimination. We provide public information and education programs, and
help Albertans resolve human rights complaints.
The Human Rights Education and Multiculturalism Fund has provided funding
for this publication.
Guide — Page 1 of 15
What you will find in this document
This document includes a guide and two forms, as noted below.
Guide:
Contact the Alberta Human Rights Commission . . . . . . . . .
Making a human rights complaint . . . . . . . . . . . . . . . . . . . .
Protected areas of discrimination . . . . . . . . . . . . . . . . . . . . .
Protected grounds of discrimination . . . . . . . . . . . . . . . . . . .
The complaint process . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
How to fill out Complaint Contact Information form
and the Human Rights Complaint Form . . . . . . . . . . . . .
Guide — Page 1
Guide — Page 3
Guide — Page 6
Guide — Page 7
Guide — Page 9
Guide — Page 13
Forms:
Complainant Contact Information . . . . . Contact Information Form — Page 1
Human Rights Complaint Form . . . . . . . . . Complaint Form — Pages 1 to 6
Please refer to How to fill out the Complainant Contact Information and the
Human Rights Complaint Form on pages 13 to 15 of this guide to help you
write your complaint.
Contact the Commission if you have questions. See page 1 of this guide for
contact information.
Guide — Page 2 of 15
Making a human rights complaint
The Alberta Human Rights Act (the Act) protects people from discrimination in
Alberta under specific protected areas and grounds. Pages 6 to 8 of this guide
briefly describe these protected areas and grounds. For more information about
the Act and the protected areas and grounds, please contact the Alberta Human
Rights Commission. See page 1 of this guide for contact information.
If you feel your safety or the safety of anyone you name during the
complaint process is at risk, please call your local police service first, then let
the Commission know.
Who can make a human rights complaint
You can make a complaint if:
1. you have reasonable grounds for believing that the Act has been contravened
(including if you believe that someone has discriminated against you);
2. another person believes, on reasonable grounds, that the Act has been
contravened and agrees that you can make a complaint on their behalf;
3. someone has retaliated against you because you have participated in a human
rights complaint or because you might participate in a complaint; or
4. you believe someone has made a frivolous or vexatious human rights
complaint against you under the Act and their intent was malicious.
See page 14 (Section C) of this guide for more information about retaliation and
frivolous and vexatious complaints.
Note that the Commission can only accept a complaint if:
1. the alleged contravention of the Act occurred in Alberta;
2. the complaint is not within the authority of the Canadian Human Rights
Commission; and
3. the complaint is made within one year of the alleged contravention of the Act.
Neither the Director of the Commission nor the Chief of the Commission and
Tribunals has the discretion to extend the one-year limit defined in the Act.
How to make a human rights complaint
To make a human rights complaint, you can:
1. Use the guide and the attached complaint form or
make your complaint in writing without using the attached form. See pages
13 to 15 of this guide to help you write your complaint in a letter to the
Commission.
2. Contact the Commission in person or by telephone if you need help to submit
a complaint and to ensure that your issues are covered under the Act. The
Commission will not respond to general human rights inquiries sent by email.
3. Provide your completed complaint form to the Commission in person, by
mail or by fax.
Guide — Page 3 of 15
The Commission must receive your completed complaint form or letter within
one year after the alleged contravention of the Act. The one-year period
starts the day after the date on which the alleged contravention of the Act
occurred. For help calculating the one-year period, contact the Commission.
See page 1 of this guide for contact information. Neither the Director of the
Commission nor the Chief of the Commission and Tribunals has the discretion
to extend the one-year limit defined in the Act.
There is no fee to make a complaint. You do not need to hire a lawyer to make a
human rights complaint. However, if you choose to have someone give you legal
advice or represent you, you are responsible for any legal costs. The Commission
does not pay legal costs for either the complainant or the respondent.
The Commission will provide information about the human rights complaint
process, but staff members of the Commission do not provide any legal advice to
either complainants or respondents. Information provided in this guide is not a
legal opinion or legal advice on the Alberta Human Rights Act or your rights.
After the Commission receives your complaint form or letter
Any person who has reasonable grounds for believing the Act has been
contravened can make a human rights complaint. When the Commission
receives a complaint, it assesses the complaint to determine if it can be accepted.
For a complaint to be accepted, it must meet the requirements set out in section
20(2) of the Act and in Commission bylaws 2(1) and 2(2), which may be
accessed through the Commission’s website.
In order to be accepted, a complaint must be received by the Commission
within one year of the alleged contravention of the Act. The Commission
cannot accept complaints made outside of this one-year limitation period. If
the alleged contravention is of an ongoing nature, then the complaint should
specify the time period that applies to the alleged contravention as a whole, and
should identify the date of the most recent alleged contravention. Any events or
allegations in a complaint that fall outside of this one-year period can only be
considered for context. Note that neither the Director of the Commission nor
the Chief of the Commission and Tribunals has the discretion to extend the oneyear limit defined in the Act.
A complaint must contain adequate detail in order to be in “a form acceptable to
the Commission” under bylaw 2(2). While complainants should provide as much
relevant information as possible about the allegations, the following information
is required in order for a complaint to be accepted:
1. the complainant’s name;
2. if the complaint is brought on behalf of someone else, the name(s) of the
individual(s);
3. where the complainant is able to provide it, the name or names of any
person, company, and/or organization alleged to have contravened the Act.
Guide — Page 4 of 15
In order to satisfy requirements contained in section 20(1) of the Act and bylaw
2(1)(a), you must provide reasonable grounds for believing that the Act has been
contravened. This means you must provide sufficient detail about the nature of
the alleged contravention of the Act (for example, specifically who said or did
what to you, and when) and explain why you believe any alleged contraventions
of the Act are linked to a protected ground. Complaint forms must be signed by
complainants, their authorized representatives, or legal counsel.
The threshold is low for acceptance of a complaint by the Commission and
at this stage, you do not need to provide evidence or witnesses to prove your
allegations, but you should attach copies of any supporting documentation or
other records that are relevant to the allegations made in the complaint.
Resolving a complaint takes time. At every step of the complaint process, the
parties are encouraged to find a resolution that is fair to both parties.
If the Commission refuses to accept your complaint, we will notify you in
writing and provide our reason(s) why the Commission cannot accept your
complaint. If you do not agree with the Commission’s decision to not accept
your complaint, you can appeal this decision to the Regional Director and, in
turn, to the Director of the Commission.
If the Commission accepts your complaint, we will send a copy of your
complaint to the party or parties that you have made a complaint against. The
Commission will ask the party or parties that you have made a complaint against
to provide a written response to the complaint and explain their point of view
about the alleged contravention(s) of the Act. A copy of the written response will
be provided to you.
More information about the complaint process
To get more information about the complaint process, you can:
1. read pages 9 to 12 of this guide;
2. contact a Commission office (see page 1 of this guide for contact
information);
3. read The Human Rights Complaint Process: A Guide for complainants;
4. read The Human Rights Complaint Process: A Guide for respondents; and
5. visit our website at albertahumanrights.ab.ca.
Guide — Page 5 of 15
Protected areas of discrimination
For more information
about protected areas,
see the Commission
information sheet
Protected areas and
grounds under the
Alberta Human
Rights Act at
The Alberta Human Rights Act protects people from discrimination in Alberta in
the protected areas described below. Most complaints will take place in only one
protected area, while many complaints will be based on more than one protected
ground (see page 7 of this guide). Please note that the descriptions below are not
legal definitions. They are guidelines to help you make your complaint.
Employment applications or advertisements applies to the use or circulation
of any job application form or job advertisement that expresses any limitation,
specification or preference based on a protected ground under the Act. It also
albertahumanrights.ab.ca applies to the written or oral questions asked of any applicants for employment.
or contact the
Commission. See page Employment practices applies to refusals to employ or to continue to
employ any person due to a protected ground under the Act. It also applies to
1 of this guide for
discrimination related to any term or condition of employment.
contact information.
Equal pay applies to situations where an individual receives a lower rate of pay
than employees of a different gender even though they do similar or the same
work for the same employer.
Goods, services, accommodation or facilities applies to goods, services,
accommodation or facilities customarily available to the public, such as those
provided by restaurants, retail stores, hotels, hospitals, schools, municipalities and
many other businesses and organizations.
Membership in trade unions, employers’ organizations or occupational
associations applies to situations where a person is excluded from becoming a
member, is expelled or suspended from membership, or is discriminated against
as a member.
Statements, publications, notices, signs, symbols, emblems or other
representations applies to the publication, issue or display before the public of
any statement, publication, notice, sign, symbol, emblem or other representation
that is discriminatory, shows an intent to discriminate, or is likely to expose
anyone to hatred or contempt. Section 3 of the Act shall be not be deemed to
interfere with the free expression of opinion on any subject.
Tenancy applies to being denied occupancy of a self-contained residential
dwelling unit or a commercial unit that is advertised or otherwise in any way
represented as being available for occupancy by a tenant. It also applies to being
discriminated against in any term or condition of the tenancy.
Guide — Page 6 of 15
Protected grounds of discrimination
For more information
about protected
grounds, see the
Commission
information sheet
Protected areas and
grounds under the
Alberta Human
Rights Act at
The Alberta Human Rights Act protects people from discrimination in Alberta
based on the protected grounds listed below, whether the protected grounds are
real or perceived. A complaint must be based on at least one of these protected
grounds. Except where noted, the descriptions below are not legal definitions.
They are guidelines to help you make your complaint.
or contact the
Commission. See the
page 1 of this guide for
contact information.
5 (tenancy) of the Alberta Human Rights Act are currently being amended
to include age as a protected ground. The Act will be amended on or before
January 6, 2018. Until the amendments are in place, the Commission will not
accept human rights complaints based on the protected ground of age in the
protected area of goods, services, accommodation or facilities or the protected
area of tenancy.
Age – as defined in the Act, means 18 years of age or older. Age is not protected
in the area of tenancy or in the area of goods, services, accommodation or
facilities. Age is protected in all other protected areas.
albertahumanrights.ab.ca Please note: Sections 4 (goods, services, accommodation or facilities) and
Ancestry – includes belonging to a group of people related by a common
heritage.
Colour – includes the colour of a person’s skin.
Family status – as defined in the Act, means the state of being related to another
person by blood, marriage or adoption.
Gender – includes the state of being female, male, transgender or two-spirited.
The ground of gender also includes pregnancy and sexual harassment.
Gender identity – refers to a person’s internal, individual experience of gender,
which may not coincide with the sex assigned to them at birth. A person may
have a sense of being a woman, a man, both, or neither. Gender identity is not
the same as sexual orientation, which is also protected under the Alberta Human
Rights Act.
Gender expression – refers to the varied ways in which a person expresses their
gender, which can include a combination of dress, demeanour, social behaviour
and other factors.
Marital status – as defined in the Act, means the state of being married, single,
widowed, divorced, separated or living with a person in a conjugal relationship
outside marriage.
Mental disability – as defined in the Act, means any mental disorder,
developmental disorder or learning disorder, regardless of the cause or duration
of the disorder. Physical disability – as defined in the Act, means any degree of physical
disability, infirmity, malformation or disfigurement that is caused by injury, birth
defect or illness and, without limiting the generality of the foregoing, includes
Guide — Page 7 of 15
epilepsy, paralysis, amputation, lack of physical coordination, blindness or visual
impediment, deafness or hearing impediment, muteness or speech impediment,
and physical reliance on a guide dog, service dog, wheelchair or other remedial
appliance or device. Place of origin – includes place of birth and usually refers to a country or
province.
Race – includes belonging to a group(s) of people, usually of a common descent,
who may share common physical characteristics, such as skin colour.
Religious beliefs – as defined in the Act, includes native spirituality.
Sexual orientation – includes gay, lesbian, heterosexual, bisexual or asexual.
Source of income – as defined in the Act, means lawful source of income. This
ground includes any income that attracts stigma to its recipients.
Guide — Page 8 of 15
The complaint process
Once a complaint is accepted, the Commission keeps all parties to a complaint
informed and welcomes questions at any time. The complainant is the person
who makes the complaint. The respondent is the person, organization or
association against whom the complaint is made. Together they are called
the “parties” to the complaint. A brief outline of the human rights complaint
process is provided below. For more detailed information, please contact the
Commission. See page 1 of this guide for contact information.
At any time during the complaint process, you may withdraw your complaint by
informing the Commission in writing.
At any time during the complaint process, the complaint may be referred to the
Director of the Commission for review. Under section 22 of the Act, the Director
may, at any time, dismiss or discontinue a complaint or continue the complaint,
including referring a complaint to tribunal.
Notifying the respondent
After the Commission accepts your complaint, the Commission sends a copy
of the complaint (excluding your contact information) to the respondent.
The respondent has 30 days from the date when they receive the copy of the
complaint to respond in writing to the Commission.
Sharing the written response with the complainant
The Commission sends a copy of the written response to the complainant. The
Commission may request additional information from the parties at this stage.
Additional information relevant to the complaint that is gathered from one party
will be shared with the other party.
The Commission may expedite a complaint to the attention of the Director
after receiving the respondent’s response. This expedited process may be used
for complaints that include sufficient information from the parties to allow the
Director to dismiss or discontinue the complaint or continue with the complaint,
including referring the complaint to a tribunal. The Commission will notify both
parties if a complaint is expedited to the Director for a decision under section 22
of the Act.
Conciliation
Conciliation is a voluntary, non-adversarial way of resolving differences. The
Commission may assign a conciliator to try to help the parties resolve their
differences. The success rate of conciliation is high; more than half of complaints
are resolved at the conciliation stage. The conciliator will help you understand
the human rights issues in the complaint, human rights law and what types of
resolutions are common in such complaints.
Guide — Page 9 of 15
“Without prejudice”
is a legal term that
means any settlement
offer or resolution
attempt made
during conciliation
is confidential and
will not be shared
with anyone at the
Commission outside
of the conciliation
process.
The complainant and respondent may meet together with the conciliator, or
each of you may meet with the conciliator separately or over the phone. The
conciliator does not take sides or investigate the complaint. If the parties resolve
their differences, the complaint is closed. If the parties cannot resolve their
differences, or if one or both of the parties decline conciliation, the complaint
may go to the investigation step of the complaint process, or it may be referred
to the Director for review. Under section 22 of the Act, the Director may, at any
time, dismiss or discontinue the complaint or continue the complaint, including
referring the complaint to a tribunal. All offers of resolution made by the parties
during conciliation are made on a “without prejudice” basis. The investigator
will not know what offers of resolution were discussed during conciliation.
Investigation
The purpose of the investigation is to gather information related to the
complaint, share collected information with the parties, seek their comments and
assess whether there is a reasonable basis to proceed with the complaint.
The Commission will inform the parties if an investigator is assigned. The
investigator is neutral and will thoroughly assess all information and consider
applicable law. If the parties want to try to resolve their differences at any point
in the investigation process, the complaint may be returned to conciliation. The
complainant may also withdraw the complaint in writing at any time and for any
reason.
If an investigation report is produced, it will be provided to both parties and either
support the complaint and recommend that there is a reasonable basis to proceed,
or it will recommend to the Director that there is not a reasonable basis to proceed.
Alternatively, during the investigation, the complaint may be expedited to
the Director of the Commission, who may decide at any time to dismiss or
discontinue the complaint or continue with the complaint, including referring
the complaint to a tribunal. The Commission will notify both parties if a
complaint is expedited to the Director for a decision under section 22 of the Act.
What happens if there is a reasonable basis to proceed?
If the information provided by the parties during any stage of the complaint
process shows that there is a reasonable basis to proceed to the next step, the
Commission may ask the parties to attempt settlement (commonly referred to as
resolution).
A remedy can be financial or non-financial compensation for losses that the
complainant experienced. A remedy is intended to restore the person who
experienced the discrimination to the position they would have been in if a
contravention of the Act had not occurred. It is not intended to punish the
respondent. Some examples of remedies include money, an apology, a change
in policy, and participation in a human rights education activity. If a complaint
is resolved, the Commission will have the parties sign an agreement. For more
information about remedies, please see the Commission’s Remedy information
sheet, which is available at albertahumanrights.ab.ca.
Guide — Page 10 of 15
If the parties agree to resolve the complaint at any time, the parties should
document and sign the agreement and provide a copy of the signed agreement
to the Commission. Alternatively, the complainant can choose to provide the
Commission a signed withdrawal of the complaint. Once the Commission
receives either of these documents, it will close the complaint.
If the complainant refuses to accept an offer from the respondent to resolve the
complaint that the Director of the Commission thinks is fair and reasonable,
the Director can discontinue the complaint. If the complaint is discontinued, it
will be closed unless the complainant requests the Chief of the Commission and
Tribunals to review the Director’s decision (commonly referred to as an appeal).
If the respondent does not offer a remedy that the Director of the Commission
considers fair and reasonable, the Director may report to the Chief of the
Commission and Tribunals that the parties are unable to resolve the complaint.
The Chief of the Commission and Tribunals then appoints a human rights
tribunal to hear the complaint.
What if there is no reasonable basis to proceed?
If the information provided by the parties during any stage of the complaint
process does not show that there is a reasonable basis to proceed with the
complaint, the Director of the Commission may dismiss the complaint under
section 22 of the Act.
What if the complainant disagrees with the Director’s decision to
dismiss or discontinue the complaint?
If the complainant disagrees with the Director’s decision to dismiss or
discontinue the complaint, the complainant can make a written request to ask
the Chief of the Commission and Tribunals to review (commonly referred to
as an appeal) the Director’s decision. The complainant must make the request
within 30 days of receiving the Notice of Dismissal or Notice of Discontinuance.
This 30-day deadline cannot be extended by either the Director or the Chief of
the Commission and Tribunals. For more information about how to request a
review, see the Commission’s information sheet Complaint Process.
If the Chief of the Commission and Tribunals agrees that the complaint
should have been dismissed or, in the case of a discontinuance, that a proposed
resolution was fair and reasonable, then the Director’s decision will be upheld
and the complaint will be closed.
If the Chief of the Commission and Tribunals decides that the complaint
should not have been dismissed or, in the case of a discontinuance, that the
proposed resolution was not fair and reasonable, then the Director’s decision will
be overturned. The Chief of the Commission and Tribunals will then ask the
complainant if they want to take the complaint to a human rights tribunal. If the
complainant chooses to take their complaint to a human rights tribunal, then the
Chief of the Commission and Tribunals appoints a tribunal. If the complainant
does not choose to take their complaint to a tribunal, then the complaint is closed.
Guide — Page 11 of 15
A decision by the Chief of the Commission and Tribunals to uphold or overturn
the dismissal or discontinuance of the complaint is final and binding, subject
only to judicial review by the Court of Queen’s Bench. A judicial review
involves particular legal principles and is not simply an appeal of the decision. A
complainant must bring an application for judicial review within six months of
the decision of the Chief of the Commission and Tribunals.
Referral to Tribunal
A complaint may be referred for hearing to a human rights tribunal: if the parties
are unable to resolve a complaint and the Director has determined there is a
reasonable basis in the evidence to proceed; if the Chief of the Commission and
Tribunals overturns the Director’s decision to dismiss a complaint; or, in the case
of discontinuance by the Director, if the Chief of the Commission and Tribunals
believes that the proposed resolution was not fair and reasonable. A human
rights tribunal is made up of one or three Members of the Commission, who are
appointed by the Lieutenant Governor in Council. The tribunal acts as a quasijudicial body—that is, they have the power to hear sworn evidence and decide
a complaint, but their hearings are less formal than a court hearing. Tribunal
hearings are usually open to the public.
More information about the tribunal process can be found on the Commission
website.
Guide — Page 12 of 15
How to fill out the Complainant Contact Information and the
Human Rights Complaint Form

If you download and print the Contact Information form and the Complaint
Form, please print one-sided and print or type only on the printed side of the
form. The back sides of all pages of the forms should be left blank.

Remove the Complainant Contact Information form and the Human Rights
Complaint Form (Complaint Form) from this document.

If you are printing rather than typing, please use a pen and print neatly. Do
not use pencil.

Complete the Complainant Contact Information form.

Complete the Complaint Form. Follow the instructions to sign and date the
form and any pages that you attach to the form. Also, number any pages that
you attach to the form and state the total number of pages you are including.

Submit the Complaint Form, including the Complainant Contact
Information, to the Commission. Ensure that you leave enough time for
the Commission to receive your Complaint Form before the one-year time
limit under the Act.

You may deliver your Complaint Form and Complainant Contact Information
form to the Commission in person, by mail or by fax.

Be sure to let the Commission know if your mailing address, phone number
or other contact information changes. It may take some time to process your
complaint. However, if you do not maintain current contact information
with the Commission, your complaint may be closed or dismissed.

Use the instructions on pages 14 and 15 and the information provided
throughout the guide to help you complete each section on the Complaint
Form. Each lettered section below refers to the corresponding lettered section
on the Complaint Form.
The Commission must receive your human rights complaint within
one year after the alleged contravention of the Act occurs.
Guide — Page 13 of 15
A Print or type your name in section A. If you are making a complaint on
behalf of someone else, include their name in the box below your name.
Whether you are complaining for yourself or making a complaint on
behalf of someone else, you are the complainant. Please note that you can
have someone help or represent you, including being the contact person for
your complaint, however, you are still the complainant.
B Print or type the respondent’s name in section B. If there is more than one
respondent, please add an extra page to your form with the name, address
and phone number of each additional respondent.
It is important to properly identify the name of the business or organization.
To locate this information, you can refer to items like records of employment,
pay stubs, business cards, letterhead and telephone listings.
If your complaint is in the protected area of employment, you must name
your employer. Typically, you will have only one employer, but if you have
questions regarding who your employer is or whether you have more than
one employer to name in the complaint, contact the Commission for
clarification. See page 1 of this guide for contact information.
If your complaint involves a protected area other than employment,
you should name the business, organization or individual that you are
complaining about.
C Complete section C only if your complaint falls into one of these categories:
1. Retaliation: It is unlawful for anyone to retaliate against you because
you have participated in a human rights complaint or because you
might participate in a complaint. Participation could include trying to
make a complaint by contacting the Commission, making a complaint
to the Commission, giving information about a complaint, or helping
someone make a complaint to the Commission. If you believe someone
has retaliated against you because you participated in a human rights
complaint, complete section C.
2. Frivolous or vexatious complaint with malicious intent: It is unlawful
for a person to make such a complaint. This would happen if a person
makes a human rights complaint to the Commission with malicious
intent. If the complaint is made with malicious intent, it must also be
frivolous (having no merit whatsoever) or vexatious (made with the sole
purpose of harassing another person). If you believe someone has made
such a complaint against you, complete section C.
Guide — Page 14 of 15
D Discrimination may take place in more than one protected area. To complete
this section, see page 6 of this guide or contact the Commission for more
information about protected areas and grounds. See page 1 of this guide for
contact information. Check () the protected areas in which you believe a
contravention of the Act took place.
E Discrimination may be based on one or more protected grounds. To complete
this section, see pages 7 and 8 of this guide or contact the Commission for
more information about protected areas and grounds. See page 1 of this guide
for contact information. Check () the protected grounds on which you
believe a contravention of the Act took place.
F The statement that you give in section F supports your complaint under the
Act and helps the Commission decide if it can accept your complaint. It is
important that you clearly describe in as much detail as possible each alleged
contravention of the Act (each alleged incident of discrimination) you are
claiming. Describe how each allegation relates to the protected areas and
grounds you checked in sections D and E. If you add extra pages, please sign,
date and number each of the extra pages.
G Have you taken any other action related to your complaint, such as grievance
proceedings or a court action? If so, and if these proceedings or actions cover
the same or substantially the same issues as your human rights complaint,
please provide details in this section and supporting documentation.
Please remember to complete the Complainant Contact Information
form and submit it to the Commission with your Human Rights
Complaint Form.
Guide — Page 15 of 15
Complainant Contact Information
Clear whole form
This is our record of your address and phone number. If any of your
personal contact information changes during the complaint process,
it is your responsibility to inform the Commission. If you do not
maintain current contact information with the Commission, your
complaint file may be closed or dismissed.
First name of complainant
Last name of complainant
Mailing address
Town or city
Home phone number
(include area code)
Work phone number
(include area code)
Province
Postal code
May we contact you at work?
Daytime phone number
(include area code)
 Yes  No
Cell phone number
(include area code)
Email address
If you are making a complaint on behalf of another person, you must provide their
contact information below.
First name of person
Last name of person
Mailing address
Town or city
Home phone number
(include area code)
Cell phone number
(include area code)
Work phone number
(include area code)
Province
Postal code
May we contact this person at
work?
Daytime phone number
(include area code)
 Yes  No
Email address
The personal information collected on this form is for the purpose of
contacting you during the proceedings of your human rights complaint
only. Your personal contact information will not be given to any person
or organization outside the Commission, except as authorized by the
Freedom of Information and Protection of Privacy Act. The Commission
will not give your personal contact information to the respondent
named in your complaint.
The Alberta Human Rights Act authorizes collection of this information. If
you have any questions or concerns about the collection of this information,
contact the Commission.
Contact Information Form — Page 1 of 1
Human Rights Complaint Form
For office use only
Date received
Clear whole form
Before you complete this form:

If you download and print the Contact Information form and the Complaint
Form, please print one-sided and print or type only on the printed side of
the form.

Do not write on the back sides of the pages of the forms. They should be
left blank.

Please see pages 13 to 15 of the guide for detailed instructions.

Please use a pen. Do not use pencil.

Completing this form does not mean that your complaint has been accepted.

The Commission must receive your complaint within one year after the alleged contravention of the Alberta
Human Rights Act. The alleged contravention must have occurred in Alberta.

Contact the Commission if you need help to complete this form. See page 1 of the guide for contact
information.

If you feel your safety or the safety of anyone you name during the complaint process is at risk, please call
your local police service first, and then let the Commission know.
A Your name (You are the complainant.)
See Guide — Page 14 item A before completing this section.
First name
Last name
Complete this box if you are making a complaint on behalf of someone else.
Name of that person
First name
Last name
The person on whose behalf you are making a complaint should sign on the line below to show that they agree that you can make the
complaint.
Signature
B Who are you complaining about? (This is the respondent.)
See Guide — Page 14 item B before completing this section.
Name of business, organization, association or person
Street or mailing address
Town or city
Province
Postal code
Telephone number (include area
code)
If there is more than one respondent, check this box .
Be sure to add the name and contact information of additional respondents on an attached page.
For office use only
Protected area(s)
Complaint deemed to meet the Commission requirements for acceptance
based on information received as of ___________________________________
Section number(s)
Date reviewed
Protected grounds(s)
File number
Human Rights Officer
Complaint Form — Page 1 of 6
Clear whole form
C Complete section C only if you are making a complaint because you believe:
• someone retaliated against you because you participated in a human rights complaint, or
• someone made a frivolous or vexatious human rights complaint about you to the
Commission with malicious intent.
See Guide — Page 14 item C before completing this section.
Please check (


 ) only the item that applies to this complaint.
retaliation
a frivolous or vexatious complaint made with malicious intent
Write a statement to explain what happened. Answer the questions that apply:
1.What has made you believe someone is retaliating against you because you participated in a
human rights complaint? What incidents have occurred to make you believe this? When did
these incidents occur?
2.What has made you believe that someone made a frivolous or vexatious human rights complaint
about you to the Commission with malicious intent? What incidents have occurred to make you
believe the complaint was frivolous or vexatious? When did these incidents occur? What makes
you think there was malicious intent?
If you need more space, please add additional pages, and remember to sign, date and number
each page. Call the Commission if you have questions.
continue on next page
Complaint Form — Page 2 of 6
Shaded area for Alberta Human Rights Commission only
Clear whole form
D Identify the protected area(s) in which the alleged contravention of the Act took place.
See Guide — Page 15 item D before completing this section.
) only those protected areas that apply to this complaint.
Please check (







Employment applications, advertisements or interviews
Employment practices
Equal pay
Goods, services, accommodation or facilities
Membership in a trade union, employers’ organization or occupational association
Statements, publications, notices, signs, symbols, emblems or other representations
Tenancy
E Identify the protected ground(s) based on which the alleged contravention of the Act
took place.
See Guide — Page 15 item E before completing this section.
) only those protected grounds that apply to this complaint.
Please check (
 Age
 Ancestry
 Colour
 Family status
 Gender (includes male, female, transgender, sexual harassment,
pregnancy)


Gender expression
Gender identity








Marital status
Mental disability
Physical disability
Place of origin
Race
Religious beliefs
Sexual orientation
Source of income
Complaint Form — Page 3 of 6
Clear whole form
F Write a statement to support your complaint.
See Guide — Page 15 item F before completing this section.
Please include all of the following information:
1.Where in Alberta did the alleged contravention of the Act take place? For example, in what city
or town or elsewhere in Alberta?
2.When did the alleged contravention of the Act take place? What incidents happened in the last
year? Provide dates (day, month and year) and details.
3.Tell us what happened and how it relates to a protected ground.
• How were you treated negatively, or differently from the way others were treated?
• What incidents have occurred to make you believe that this treatment was linked to the
protected ground(s) that you checked in Section E? Include dates.
• Please provide details and supporting documents for each protected ground you have checked
in Section E, and call us if you have any questions.
• Please write your information in chronological order.
continue on next page
Complaint Form — Page 4 of 6
Shaded area for Alberta Human Rights Commission only
Clear whole form
If you need more space, please add additional pages, and remember to sign, date and number
each page.
Complaint Form — Page 5 of 6
Clear whole form
G Have you taken any other action related to your complaint, such as grievance
proceedings or a court action?
If so, and if these proceedings or actions cover the same or substantially the same issues as
your human rights complaint, please provide details in this section and include supporting
documentation.
See Guide — Page 15 item G before completing this section.
If you need more space, please add additional pages, and remember to sign, date and number
each page.
Complainant’s signature Date
The Alberta Human Rights Commission may not accept your complaint if information is missing or if you do
not sign this form. Please sign, date and number each page you add to the form and state the total number
of pages included.
Complaint Form — Page 6 of 6