Sexual Harassment Complaint Form
Employee Name
		
Department
		
Title
		
Todays Date
		Age
		sex
		
Date of Incident
		Time of Incident
		
Person(s) you allege committed the sexual harassment
	
Name
	Position/Title

		

		

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

	

	

	

	

	

	

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