This form will allow an employee to file a sexual harassment complaint.
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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
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