You are here

502.91E1 Harassment Complaint Form

HARASSMENT COMPLAINT FORM 

Name of complainant:

 

Position of complainant:

 

Date of complaint:

 

Name of alleged harasser:

 

Date and place of incident or incidents:

 

Description of misconduct:

 

 

Name of witnesses (if any):

 

Evidence of harassment, i.e., letters, photos, etc. (attach evidence if possible):

 

Any other information:

 

I agree that all of the information on this form is accurate and true to the best of my knowledge.

Signature:  _________________________________________      Date: _________________________