Sample Harassment Complaint Form

Whether your an employer of a small business or a big one, every HR department knows the importance of operating withing ODEP and EEOC laws. Here is a suggested harassment form from the EEOC (Equal Employment Opportunity Commission).

This is useful even if you are an employee and in need of filing a complaint. You can use this form as a good starting point to document your harassment complaint!

What do YOU think?



Sample Harassment Complaint Form

The Equal Employment Opportunity Commission (EEOC) says any complaint procedure where the only person an employee can complain to is his or her supervisor is an ineffective system-especially, of course, when the supervisor is the harasser. EEOC advises employers to set up multiple avenues of recourse for a complainant.

EEOC further advises that employees who wish to make a complaint of harassment should have the option to complain to someone who is outside of their chain of command, to place confidence in the complainant that the complaint will be handled with impartiality.

Therefore, designate at least two people in the company who employees can approach with an initial complaint, and be sure that they are not in the same chain of command. (Two is a minimum; large companies will surely have to increase the number.)


Sample Harassment Complaint Form

Here is a sample of what you might use for employees to file complaints. It should help you collect
enough specific information to determine what course of action is necessary.

Name: _____________________________________
Department: ________________________________
E-mail address: ________________________
Phone: Home: ____________ Work: ____________ Cell: _____________

Date: _______________

Please provide a detailed description of the behavior or incident (s) about which you are making
a complaint or attach the description to this form. Include the following information and anything
else that would help management understand your complaint:

What happened:

Who was involved:

When the incident(s) took place:

Where the incident(s) took place:

Who (if anyone) witnessed the incident(s):

Please also attach any documents, e-mails, or other materials that support your claim of harassment.

What would you like the company to do to resolve this issue?


____________________________
Signature
____________________________
Date

Submit this form to: ________________________________