Employee Harassment Complaint Form Template

In the modern workplace, ensuring a safe and harassment-free environment is not just a legal obligation; it’s fundamental to employee well-being, company culture, and organizational success.

Implementing a standardized process for handling harassment complaints can be a significant step toward this goal. 

This “Employee Harassment Complaint Form” offers a comprehensive and organized structure to capture essential details related to such complaints.

By using this form, you can ensure that every grievance is documented systematically, leading to more effective and thorough investigations.

Moreover, it demonstrates the organization’s commitment to addressing and preventing harassment, fostering trust and openness within your team.

Employee Harassment Complaint Form

Personal Details of Complainant:

Full Name: _________

Employee ID: _________

Position/Title: _________

Department: _________

Contact Number: _________

Email Address: _________

Details of the Accused (if known):

Full Name: _________

Employee ID: _________

Position/Title: _________

Department: _________

Incident Details:

Date of Incident: ____/____/____

Time of Incident: ________:________

Location of Incident: _________

Witnesses (if any):

1. _________
2. _________

(Add more if needed)

Nature of Harassment (Please check the relevant box):

[  ] Verbal 

[  ] Physical

[  ] Visual (e.g., pictures, gestures)

[  ] Cyberbullying or online harassment

[  ] Other: _________

Detailed Description of the Incident:

(Please provide a thorough description of what happened. Attach additional sheets if necessary)

_________

Supporting Evidence:

(Please list any supporting evidence you might have, e.g., emails, text messages, photos. Attach copies if possible, but ensure originals are kept safe.)

1. _________
2. _________

(Add more if needed)

Actions Desired:

(What would you like to see happen in response to this complaint? This can be kept blank if you’re unsure.)

_________

Declaration:

I, _________ (Full name of the complainant), declare that the information provided in this form is true and accurate to the best of my knowledge. I understand that providing false information can have serious consequences.

Signature: _________       Date: ____/____/____

—

For Office Use Only

Received By: __________

Date: ____/____/____

Initial Actions Taken:

__________

Ensuring that every harassment complaint is treated with seriousness, confidentiality, and sensitivity is crucial for an organization’s integrity and the well-being of its employees.

Using a structured form like this ensures that all relevant information is captured, aiding in a thorough investigation and appropriate action.

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