Harassment Complaint

1
Your Name* This field is required.Person making the complaint
First Name
Last Name
2
Your Work Location* This field is required.Site Name
3
Your Phone Number
Please enter a valid phone number.
4
Your Rank* This field is required.
5
Your Email* This field is required.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code?or
Receiving the email may take a few minutes, thank you for your patience!
6
Select Preferred Communication Method:* This field is required.How should we contact you
Email
Phone
In Person
7
Your Supervisor* This field is required.
First Name
Last Name
8
Supervisor's Rank* This field is required.
9
Supervisor's Phone Number* This field is required.if known
Please enter a valid phone number.
10
Supervisor's Work Location* This field is required.site name
11
Name of Accused* This field is required. Please tell us who you believe has violated our policy against non-harassment, including sexual harassment. What is their relationship to you (e.g.,supervisor, subordinate, co-worker,other)?
12
Rank* This field is required.Rank of the Accused
13
Phone Number* This field is required.Phone number of the Accused if known
Accused Phone if known.
14
Accused's Work Location* This field is required.Site where the accused works
15
Accused's Relationship to you:* This field is required.Is The person your
Supervisor
Subordinate
Co-Worker
Other
16
Please describe what happened and how it is affecting you and your work. Please use additional sheets of paper if necessary and attach any relevant documents or evidence.* This field is required.
17
Additional documents or evidence
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
18
Was additional documents or evidence uploaded
YESNO
19
Date(s) harassment occurred:* This field is required.
20
Type a question
YESNO
21
Please list the name and contact information of any witnesses or individuals who may have information related to your complaint: * This field is required.
22
Have you previously complained or provided information (verbal or written) about related incidents? If yes, when and to whom did you complain or provide information?* This field is required.
The last question is optional, but may help the investigation.
23
If you have retained legal counsel and would like us to work with them, please provide their contact information.* This field is required.
Name, address and telephone.
24
Date* This field is required.today's date
Date
Month
Day
Year
25
Signature* This field is required.
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