Sexual Harassment Complaint

Sexual Harassment Complaint

Fields: employee name, department, title, age, sex, date of incident, time of incident, person(s) you allege committed the sexual harassment, name, position/title

Please describe the incident in detail, including your reaction to incident:

Person(s) who witnessed the incident, if any:

Additional Notes:

I understand that this matter will need to be investigated, but that all the information will be kept confidential to the extent that it is possible.

________                ________________________________
Date                                    Employee Signature