Sexual Harassment Complaint Form
Sexual Harassment Complaint Form
Please fill out this form to submit a complaint.
Complainant Information
Name
Job Title
Phone number
Address
Preferred Contact Method
-
Phone
-
Email
-
In Person
-
Date of Complaint
Person(s) Involved
No. of Person(s) Involved
Person 1
Name
Job Title
Relationship to the Complainant
-
Supervisor
-
Co-worker
-
Client/Customer
-
Contractor
-
Vendor
-
Phone number (if available)
Email (if available)
Address (if available)
Person 2 (if applicable)
Name
Job Title
Relationship to the Complainant
-
Supervisor
-
Co-worker
-
Client/Customer
-
Contractor
-
Vendor
-
Phone number
Address
Person 3 (if applicable)
Name
Job Title
Relationship to the Complainant
-
Supervisor
-
Co-worker
-
Client/Customer
-
Contractor
-
Vendor
-
Phone number
Address
Complaint Information
Date and Time of the Incident
Location of the Incident
Did the sexual harassment continue after the initial incident?
Please explain the incident(s) in detail:
Supporting Documents
Please provide any evidence related to your complaint. This may include documents, emails, photos, audios or other relevant files.
Have you previously reported or discussed any incidents of sexual harassment verbally or in writing?
If yes, to whom and when?
Witness Details (if available)
|
Name |
Relationship to Complainant |
Contact Information |
|---|---|---|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Legal Counselor
Do you have a legal counselor?
Name
Phone number
Additional Information
Acknowledgement
By signing below, I affirm that the information provided in this complaint form is true and accurate to the best of my knowledge and belief.
Name:
Date:
Complaint Form Templates @ Template.net
Thank you for bringing this matter to our attention.
We will review your submission and will reach out with next steps.
Create free forms at Template.net
