Workplace Harassment Complaint Form
Workplace Harassment Complaint Form
Please complete this Workplace Harassment Complaint Form to evaluate and document any incidents of harassment within the workplace.
Name of Complainant
Date
Phone number
Date of alleged incident
Name of person you believe harassed you
Where did the incident occur?
Has this happened before?
If the alleged harassment was toward another person, identify that other person:
Describe the incident as clearly as possible. Include a complete description of the events, verbal statements, and any physical contact:
How did you or the person harassed react to the harassment?
List any witnesses who were present:
Certification
I hereby certify that the information I have provided in this complaint is true, correct, and complete to the best of my knowledge.
Name:
Date:
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