Check the factor(s) below that you believe apply. Note: If your claim is based on disability, please complete questions 12 – 16 located on page 4.The Broward County EEO Complaint Form is designed for individuals to report incidents of discrimination or harassment in the workplace. Please be as specific as possible. A charge of discrimination can be completed through our online system after you submit an online inquiry and we interview you. Gallup Auerbach protects South Florida employees against racial discrimination at work. You are entitled to file a complaint for any alleged violation no later than 180 days from the date of the discrimination. Title VI Complaint Procedure. All complaints shall be filed no later than 180 days from the date of the alleged discrimination. Completing this form does not constitute filing an official complaint with a legal authority.