Form
Appendix: Workplace Bullying & Harassment Complaint Form
January 14, 2014Page 441 section
The standard intake form for employees to report incidents of alleged bullying or harassment.
Requires details of complainant, respondent, witnesses, and nature of allegations
Workplace Bullying & Harassment Complaint Form
| Name of Complainant: | |
| Person(s) suspected of harassment (Respondent): |
Nature of the allegations
| Incident | Date | Time | Place |
|---|---|---|---|
| Did anyone witness the incident? | [ ] YES [ ] NO |
|---|---|
| If YES | Name of witness(es): |
| Description of their respective role in the incident: | |
| How did you react to the harassment? | |
| If applicable, describe any incident that took place previously: |
I hereby certify that to the best of my knowledge the above-mentioned information is true, accurate and complete. Making false or frivolous allegations is in violation of this policy and subject to disciplinary sanctions.
Furthermore, I realize that an inquiry will be initiated once this complaint has been filed.
Signature of the Complainant
Date
Page 44
Document Images
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Extracted from: 2014 01 14 Committee of the Whole Agenda