3 minutes
An individual who believes that they have been the victim of workplace harassment may file a complaint with their employer.
Your complaint of Sexual Harassment is made about
Name(s) of individual engaged in the harassment:
Please describe the specific incident of harassment alleged. Describe each incident separately,including dates, times and locations. If you cannot remember exact dates, times or locations,please provide approximations.
Are there others who may have witnessed this alleged harassment? If so, please provide their name(s).
Are there others who may have experienced similar alleged harassment by the individual named above? If so,please provide their name(s).
Did you tell anyone about your experience after the alleged incident(s)? If yes, please provide their name(s).
Are there others who have witnessed this behavior or others who experienced similar behavior by the individualnamed above? If so, please provide their name(s) and state whether they are a witness to this behavior or anindividual who has experienced similar behavior:
Did you speak to the individual named in this report about the alleged harassment? If yes, what was his or herresponse?
Is the sexual harassment continuing?