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Sexual Harassment Complaint Form

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jaigovind boob
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24 views3 pages

Sexual Harassment Complaint Form

Uploaded by

jaigovind boob
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Sexual Harassment Complaint Form

Information about Complainant

Employee name:

Job title:

Phone number:

Email:

Work address

Which one(s) do you prefer to be contacted by?

● Email
● Phone
● In-person
● Other

Information about Supervisor

Name of supervisor:

Title:

Work phone number:

Information about Complaint

Name of complaint:

Title:

Work phone number:


Email:

Work address

Relationship to the complainant

● Supervisor
● Subordinate
● Co-worker
● Other

Sexual Harassment Information

Please enter the date(s) the sexual harassment was occurred. If you remember the time(s), you can
enter.

Date

Time

Does sexual harassment continue?

● Yes
● No

Please explain what happened in detail.


Have you ever complained or provided information verbally and/or in writing about sexual
harassment?

● Yes
● No

Please give more detail

Witness/Witnesses (if any):

Do you have a legal counselor and would like us to work with them?

● Yes
● No

If yes, please give your legal counselor's contact information:

Date:

Signature_____________

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