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.
Full Name
Age
Date of Birth
Phone Number
Email Address
Home Address
Nationality
How do you identify yourself?
Are you filing this complaint on behalf of another individual? If so, please provide that individual's contact information.
What is the nature of the harassment you have experienced? Please describe the incident(s) in detail.
Location of alleged harassment
Do you have any witnesses? If so, please provide their name, contact information, and relationship to you.
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?
Have you previously filed a complaint against this individual?
Do you have any other information that you believe would be helpful in investigating this complaint?
Is there anything else you would like to add?
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