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Harassment documentation form

This harassment documentation form is to be used by employees who believe that they have been subjected to harassment in the workplace. The form will document the employee's account of the incident/s, as well as any witnesses to the incident/s. This documentation will be used to investigate the employee's claims of harassment.

3 minutes to complete

Eligibility

Any person who is a victim of harassment can fill out a harassment complaint form. The victim can be male or female.

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Questions for Harassment documentation form

Questions

1.

What is your name?

The answer should be a text input.
2.

What is your age?

The answer should be a text input.
3.

What is your gender?

The answer should be a single choice:
  1. Male
  2. Female
4.

What is your race or ethnicity?

The answer should be a text input.
5.

What is your current relationship status?

The answer should be a single choice:
  1. Single
  2. Married
  3. Seperated
  4. Divorced
6.

What is your current job or occupation?

The answer should be a text input.
7.

Have you ever experienced harassment?

The answer should be a single choice:
  1. Yes
  2. No
8.

If yes, please describe the incident or incidents in as much detail as possible.

The answer should be a text input.
9.

When did the incident or incidents occur?

The answer should be a text input.
10.

Where did the incident or incidents occur?

The answer should be a text input.
11.

Who was the perpetrator or perpetrators?

The answer should be a text input.
12.

Was the perpetrator or perpetrators known to you?

The answer should be a single choice:
  1. Yes
  2. No
13.

If yes, how were they known to you?

The answer should be a text input.
14.

Have you taken any action in response to the incident or incidents?

The answer should be a single choice:
  1. Yes
  2. No
15.

What was the action taken?

The answer should be a text input.

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Here are some FAQs and additional information
on Harassment documentation form

How do I document a harassment incident?

If you have been the victim of harassment, you can document the incident by completing a harassment documentation form. This form is usually available online and in the Human Resources office.

Who should I give the completed form to?

The completed form should be given to your supervisor, the Human Resources office, or the Equal Employment Opportunity/Affirmative Action office.

What information should I include on the form?

When documenting an incident of harassment, you should include as much information as possible, including: • The date, time, and location of the incident • A description of the incident • The name(s) of any witnesses • The name(s) of the person(s) involved in the incident

What happens after I submit the form?

After you submit the form, an investigation will be conducted.

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Harassment documentation form
This harassment documentation form is to be used by employees who believe that they have been subjected to harassment in the workplace. The form will document the employee's account of the incident/s, as well as any witnesses to the incident/s. This documentation will be used to investigate the employee's claims of harassment.
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