The complexity and nuance involved in managing workplace discrimination complaints within the Department of the Army are encapsulated within the structure and use of the EEO Counselor's Report, or the 7510 form. This document serves as a crucial first step in the formal documentation and processing of allegations concerning discrimination based on a variety of factors including race, color, national origin, religion, sex, age, disability, and reprisal against civilian employees, applicants for employment, and certain contract employees within the realm of the Army. Structured to capture comprehensive details regarding the aggrieved individual, the alleged discriminatory action, and preliminary steps towards resolution, the form emphasizes the procedural steps prescribed by AR 690-600. It underscores the requirement for voluntary disclosure, though it cautions against incomplete submissions as they may hamper the complaint's progress. Additionally, it outlines specific timelines within which actions are to be taken, details the choice between alternative dispute resolution methods and traditional counseling, and delineates the rights and responsibilities of the parties involved. This structured approach not only aids in streamlining the processing of complaints but also serves to provide statistical data for analytical reviews of the complaint resolution process, responds to freedom of information requests, and assists in the adjudication of complaints.
| Question | Answer |
|---|---|
| Form Name | Form 7510 |
| Form Length | 5 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min 15 sec |
| Other names | yyyymmdd conducted telephonically online, pritable form 7501, form 7510 da, da form 7510 fillable |
EEO COUNSELOR'S REPORT
For use of this form see AR
1. DA DOCKET NUMBER
AUTHORITY:
PRINCIPAL PURPOSE:
PRIVACY ACT STATEMENT (5 U.S.C. §552a)
Public Law
Used for processing of complaints of discrimination because of race, color, national origin, religion, sex, age, physical and/or mental disability, or reprisal by Department of the Army civilian employees, former employees, applicants for employment and some contract employees.
ROUTINE USES: Information will be used (a) as a data source for complaint information for production of summary descriptive statistics and analytical studies of complaints processing and resolution efforts; (b )to respond to general requests for information under the Freedom of Information Act; (c ) to respond to requests from legitimate outside individuals or agencies
(White House, Congress, Equal Employment Opportunity Commission) regarding the status of a complaint or appeal; or
(d)to adjudicate complaint or appeal.
DISCLOSURE: Voluntary, however, failure to complete all appropriate portions of this form may lead to delay in processing and/or rejection of complaint on the basis of inadequate data on which to continue processing.
SECTION l -
2. NAME OF AGGRIEVED
3. JOB TITLE
4. PAY PLAN/SERIES/ |
5. DUTY ORGANIZATION (Complete address including office symbol) |
GRADE |
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WORK TELEPHONE |
7. HOME TELEPHONE |
8. HOME ADDRESS |
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DATE OF ALLEGED |
10. 45THCALENDAR DAY |
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REASON FOR DELAYED CONTACT BEYOND 45 DAYS, IF APPLICABLE |
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DISCRIMINATORY ACTION |
AFTER EVENT (YYYYMMDD) |
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12. DATE OF INITIAL |
13. 30TH CALENDAR DAY |
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90TH CALENDAR DAY AFTER |
15. DATE COUNSELING |
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CONTACT WITH EEO |
AFTER INITIAL CONTACT WITH |
INITIAL CONTACT WITH EEO OFFICIAL |
EXTENSION GRANTED, IF |
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OFFICIAL (YYYYMMDD) |
EEO OFFICIAL (YYYYMMDD) |
(YYYYMMDD) |
APPLICABLE (YYYYMMDD) |
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16.DATE
17.
Telephonically |
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Other |
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SECTION II - ORGANIZATION WHERE ALLEGED DISCRIMINATION OCCURRED (Complete address including office symbol)
SECTION III - RESPONDING MANAGEMENT OFFICIAL(s) INFORMATION (Include name, complete work address and phone number if known.)
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SECTION IV - BASIS OF COMPLAINT (Identify specific race, color, religion, national origin, disability, age, sex, or reprisal if alleged.)
RACE |
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AGE |
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DATE OF BIRTH |
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RELIGION |
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DISABILITY |
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REPRISAL |
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SEX |
Male |
Female |
NATIONAL ORIGIN
Physical
(Date(s) of prior EEO activity)
SECTION V - MATTER(S) GIVING RISE TO COMPLAINT (Specify who, what, where, and when.) (Use additional sheet of paper if necessary.)
SECTION Vl - RELIEF SOUGHT
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SECTION Vll - RIGHTS AND RESPONSIBILITIES
THE AGGRIEVED WAS PROVIDED WITH THE AGGRIEVED PERSON'S RIGHTS AND RESPONSIBILITIES NOTICE AND WAS SPECIFICALLY ADVISED OF THE FOLLOWING:
The basis(es) for filing
The
The
The role of the EEO counselor, including that the counselor is not an advocate for either the aggrieved person or the agency and acts strictly as a neutral.
The activity's Alternate Dispute Resolution ( ADR) Program and right to elect either ADR (if offered) or traditional EEO counseling.
The right to remain anonymous during the
The right to representation throughout the complaint process.
Responsibility of the aggrieved to notify the EEO office in writing of any change in address and/or phone number.
Responsibility of the aggrieved to notify the EEO office in writing of
The possible election requirement between a negotiated grievance procedure, MSPB procedure and the EEO complaint process. The election options in age and
SECTION Vlll - ELECTION OF REPRESENTATION
ATTORNEY |
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NAME OF REPRESENTATIVE |
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TELEPHONE NUMBER
FAX
SECTION IX - ALTERNATE DISPUTE RESOLUTION (ADR)
Matter determined not appropriate for ADR
(Aggrieved must sign and date)
Matter determined appropriate for ADR
(EEO Officer must initial and date)
Wishes to participate in ADR, if offered
(EEO Officer must initial and date)
Date of written offer of ADR
Date of Agreement to Participate in ADR
Name of assigned ADR facilitator/mediator
Date ADR facilitator/mediator assigned
Result of ADR:
ADR was successful. Negotiated settlement agreement, signed on(YYYYMMDD), is attached.
ADR was not successful. The aggrieved was issued a Notice of Right to File a Formal Complaint of Discrimination on
(YYYYMMDD) and notified of requirement to file a formal complaint within 15 calendar days after receipt of Notice of Right to File. The aggrieved was provided a DA Form 2590, Formal Complaint of Discrimination.
SECTION X - TRADITIONAL EEO COUNSELING (EEO official to complete only those which apply.)
Election of traditional counseling.
Name of assigned EEO counselor
Date EEO counselor assigned
Election to remain anonymous.
Election to waive right to remain anonymous.
Declined to pursue matter under Title VII.
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SECTION Xl - WITNESS INQUIRY
a.Witness Information (List all witness data here. Number sequentially and include name, title, organization, phone number, and relevant basis(es) information.)
b. Witness Statements
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SECTION Xl - WITNESS INQUIRY (Cont'd)
Witness Statements (Cont'd)
c. Documents Reviewed (List)
d. Reviewed Documents Revealed
SECTION Xll - OUTCOME OF
Resolution was not accomplished, therefore, I conducted the final interview with aggrieved on |
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(YYYYMMDD) at which |
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time I informed the aggrieved of the full scope of my inquiry and the reason(s) articulated by management for action(s) taken. |
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I provided the aggrieved with a Notice of Right to File a Formal Complaint of Discrimination and a DA Form 2590, Formal Complaint of |
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Discrimination. The aggrieved is aware of the requirement to file a formal complaint within 15 calendar days of the final interview if not |
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satisfied with the results of my inquiry. |
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Resolution was accomplished. Negotiated settlement agreement, signed on |
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(YYYYMMDD), is attached. |
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PRINTED NAME OF EEO COUNSELOR |
SIGNATURE OF EEO COUNSELOR |
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Attachments: |
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DATE SUBMITTED TO EEO OFFICER |
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1. Extension of counseling (if applicable) |
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(YYYYMMDD) |
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2. Copies of reviewed documents |
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DA FORM 7510, JUL 2010 |
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