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Harassment Complaint Form

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Harassment Complaint Form Powered By Docstoc
					Harassment Complaint Form
Properly investigate harassment claims within your company with this customizable
Harassment Complaint Form. Select which questions will be included on the form and
you will have a blank template that can be distributed to employees within your
company. This form is ideal for small businesses that want to maintain a safe and
cordial working atmosphere by giving employees the opportunity to report harassment
claims.
                                      Harassment Complaint Form

                                     COMPLAINANT INFORMATION

Name of Complainant: ______________________________

Complainant Employee I.D. #: ________________________________

Complainant Employee Department: _________________________________

Complainant Employee Title: ________________________________

                                                ALLEGED PARTY

Date of Complaint: _______________________

Date of Alleged Incident: ____________________

Name(s) of Alleged Harasser(s): _________________________________________________

Witnesses: ___________________________________________________________________

                                              ALLEGED INCIDENT

Describe the specific harassment incident in detail. Include dates, times, and locations:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Have any other people within the company have experienced similar harassment by the
alleged harasser? If so, provide their name(s) here:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Did you tell anybody what happened after the alleged incident? If so, please provide their
name(s) here:


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______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________

Did you speak to the alleged harasser about the incident? If so, what was their response?

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________


                                     COMPLAINANT AUTHORIZATION
I swear that the information provided on this form is true and correct and that I am not willfully
making false harassment claims. I also understand that I will not be retaliated against for making
this allegation.

Complainant Signature: _____________________________________ Date: _____________

                                   ACKNOWLEDGMENT OF RECEIPT
Name of Person Receiving Complaint: __________________________________
Signature of Person Receiving Complaint: _________________________________
Title: ______________________________
Date: ________________________________




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DOCUMENT INFO
Description: Properly investigate harassment claims within your company with this customizable Harassment Complaint Form. Select which questions will be included on the form and you will have a blank template that can be distributed to employees within your company. This form is ideal for small businesses that want to maintain a safe and cordial working atmosphere by giving employees the opportunity to report harassment claims.
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