About this document
What this document is
A workplace form used by employees, interns, contractors or other affected persons to report alleged sexual harassment for internal handling.
Purpose
It creates a clear written record for an employer or designated officer to receive, assess and respond to a sexual harassment complaint fairly and confidentially.
Key components
- Complainant and respondent details to identify the people involved and safe contact methods
- Complaint details to record dates, locations, conduct and the effect of the alleged behaviour
- Witness and evidence record to identify supporting information and preserve relevant materials
- Prior reporting and immediate safety needs to record earlier disclosures and requested protections
- Requested outcome to state the complainant’s preferred next steps without limiting the employer’s process
- Confidentiality and non-retaliation notice to explain handling expectations and reporting of adverse treatment
- Declaration and acknowledgement to confirm the report is made in good faith and received for review
- Receiving officer record to document intake, referrals, risk measures and follow-up actions
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