LGBT Harrassment Complaint Form

This form is used to report incidents of harassment or discrimination faced by the LGBTQ community. Information that is collected on this form will be used to investigate the incident and take appropriate action.

3 minutes to complete


The LGBT harassment complaint form is filled by members of the LGBT community who have experienced harassment at the workplace or elsewhere.


Questions for LGBT Harrassment Complaint Form



Full Name

The answer should be a text input.


The answer should be a single choice:
  1. Under 18
  2. 18-24 years old
  3. 25-34 years old
  4. 35-44 years old
  5. 45-54 years old
  6. Over 55

Date of Birth

The answer should be a date input.

Phone Number

The answer should be a phone number.

Email Address

The answer should be an email input.

Home Address

The answer should be a text input.


The answer should be a country.

How do you identify yourself?

The answer should be a single choice:
  1. Lesbian
  2. Gay
  3. Bisexual
  4. Transgender

Are you filing this complaint on behalf of another individual? If so, please provide that individual's contact information.

The answer should be a text input.

What is the nature of the harassment you have experienced? Please describe the incident(s) in detail.

The answer should be a text input.

Location of alleged harassment

The answer should be a text input.

Do you have any witnesses? If so, please provide their name, contact information, and relationship to you.

The answer should be a text input.

Have you contacted the individual or organization against whom you are filing the complaint in an attempt to resolve the issue? If so, what was the outcome?

The answer should be a text input.

Have you previously filed a complaint against this individual?

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

Do you have any other information that you believe would be helpful in investigating this complaint?

The answer should be a text input.

Is there anything else you would like to add?

The answer should be a text input.

Forms Similar to LGBT Harrassment Complaint Form

  • LGBT Harassment Complaint Form
  • Harassment Incident Report Form
  • Sexual Harassment Complaint Form
  • Workplace Harassment Complaint Form
  • Student Harassment Complaint Form Harassment Complaint Form - Schools Domestic Violence/Harassment Complaint Form

Here are some FAQs and additional information
LGBT Harrassment Complaint Form

How do I file a LGBT Harrassment complaint?

You can file a complaint by filling out and submitting an LGBT harassment complaint form.

What information do I need to include in LGBT Harrassment complaint?

When you file a complaint, you will need to provide your contact information, as well as the contact information of the person or entity you are filing the complaint against. You will also need to describe the alleged harassment in detail, including dates, times, and locations.

How long will it take to process my complaint?

It will generally take our office 3-5 business days to process your complaint.

Want to use this template?

Loved by people at home
and at work

“BlockSurvey is a simple, effective, and scalable tool for creating surveys for leadership and learning assessment. It's one of this year's best buying choices. Each month, it keeps improving and strives to serve its customers needs.”
Nelson Emilio
Personal Branding Strategist
“I use BlockSurvey to get feedback about all my activities and events. It is really easy to get started and create my first surveys! Then I could see how easy it was to share them. Now I am thinking to use BlockSurvey also within my creative process as an author in order to listen and engage with my audience, knowing that anonymity provides the most sincere and reliable answers.”
Georgina García-Mauriño
Author & Designer
BlockSurvey social proof
G2 Crowd
4.8 Star Rating
BlockSurvey social proof
Editor's choice
BlockSurvey social proof
4.9 Star Rating

What's next? Try out templates like
LGBT Harrassment Complaint Form

1000+ Templates, 50+ Categories

Want to create secure online forms and surveys?

Join BlockSurvey.