Update Agency Designee Form

Per Governor Kemp's Executive Order 01.14.19.02, each executive branch agency shall designate two persons, not of the same gender, to investigate complaints of sexual harassment. Agencies shall report to the Office of the State Inspector General the names and contact information for their designated investigators utilizing the form below. Should a vacancy in an investigator or human resources contact role occur, agencies shall designate a replacement and report the updated name(s) and contact information to the OIG within seven business days of the vacancy.

A submission is required for each designated investigator and human resources contact. You may also update contact information or remove prior investigators and designees via this form.

Please identify the type of submission:

New Designee

Update to Existing Designee

Replace Existing Designee

Remove Existing Designee

If updating, replacing, or removing an existing designee, provide the name of the existing designee:

Is this designee an investigator or human resources contact?

Designee Information

Name

Does this designee have a Peoplesoft Employee ID Number?

Yes

Employee ID Number

Sex

Male

Female

Phone Number

Email Address

Job Title

State Agency or Department

If "Other", please identify agency or department:

Work Address

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