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Workplace Harassment Complaint Form

Internal complaint form for reporting workplace harassment, discrimination, or hostile work environment, triggering the employer's investigation obligations.

PDF TemplateUse the instructions below to complete this form

Instructions

Describe the harassing behavior with specific dates, times, locations, and what was said or done. Identify the person(s) engaging in the behavior. List any witnesses. Describe any impact on your work performance or work environment. Note any prior complaints, verbal or written. Employers have a legal obligation to promptly investigate and take corrective action. Retaliation against complainants is prohibited under federal and state law.