Legal Sexual Harassment Complaint Form

LEGAL SEXUAL HARASSMENT COMPLAINT FORM

Complainant Name:   Employee ID:   Position/Title:

Department:   Work Location:

Employer Name:   HR Contact:

Date of Filing: Month Day Year

RECITALS

WHEREAS, the Complainant submits this written complaint to report incidents constituting sexual harassment as defined under applicable workplace policy and governing law, and to request a formal investigation and appropriate remedial action; and

WHEREAS, the Employer has an obligation to maintain a workplace free from sexual harassment, to investigate complaints promptly and impartially, and to take corrective measures where misconduct is found; and

WHEREAS, the parties intend that the procedures set forth herein shall define the submission, investigation and handling of this complaint consistent with legal obligations and protections against retaliation.

NOW, THEREFORE, the Complainant hereby provides the following report and authorizes the Employer to proceed with investigation and remedial measures as set forth below.

1. INCIDENT SUMMARY

Month Day Year   Time (if known):

2. PRIOR REPORTING

Yes    No

3. EVIDENCE AND SUPPORTING MATERIALS

Yes    No

4. REMEDIES, INTERIM MEASURES, AND RELIEF REQUESTED

5. INVESTIGATION PROCESS AND RIGHTS

The Employer shall undertake a prompt, thorough, and impartial investigation of the allegations. The investigation may include interviews, review of relevant documents, and collection of other evidence. The Employer will make reasonable efforts to keep the matter confidential consistent with the need to conduct a full investigation and to take corrective action when appropriate.

The Complainant has the right to be accompanied by a representative or support person during investigatory interviews, subject to reasonable limitations and prior notice to the investigator. The Complainant also has the right to be informed of the outcome of the investigation in writing to the extent permitted by law and organizational policy.

6. NON-RETALIATION

The Employer prohibits retaliation against any person who in good faith files a complaint, participates in an investigation, or assists in any related proceeding. Retaliation is prohibited and may result in disciplinary action up to and including termination.

7. CERTIFICATION AND AUTHORIZATION

By signing below, the Complainant certifies under penalty of perjury that the information provided in this complaint is true and accurate to the best of the Complainant's knowledge and belief. The Complainant authorizes the Employer to investigate the allegations, to contact witnesses and relevant third parties, and to review records necessary to resolve the complaint. The Complainant understands that knowingly making false statements or submitting false evidence may subject the Complainant to disciplinary action.

I certify that the foregoing is true and accurate and I authorize the investigation as described.

8. PRIVACY, DISCLOSURE AND RECORDS

Information obtained during the investigation will be maintained in investigatory files and personnel records as appropriate. Such records may be disclosed to third parties only as required by law, to persons involved in the investigation, or to those with a legitimate need to know. The Employer will inform the Complainant to the extent disclosure is required by law.

9. NOTICES

10. GOVERNING LAW; MISCELLANEOUS

This Complaint and any investigation, including any administrative action taken by the Employer in response to this Complaint, shall be governed by and construed in accordance with the laws of the state or jurisdiction where the alleged conduct occurred, without regard to conflict of law principles.

Entire Agreement: This written Complaint contains the entire statement of allegations and requests as submitted by the Complainant and supersedes any prior oral or written statements regarding the same incidents.

Severability: If any provision of this Complaint is held invalid or unenforceable, the remaining provisions shall continue in full force and effect.

Amendments and Waiver: Any amendment or waiver of provisions of this Complaint must be in writing and signed by the Complainant and an authorized representative of the Employer.

11. SIGNATURES

The undersigned parties acknowledge receipt of this Complaint and agree to proceed with the investigatory and administrative processes described above. The Complainant's signature below affirms the truthfulness of the information provided. The Employer's signature below acknowledges receipt and indicates that the Employer will initiate an appropriate investigation and take actions consistent with applicable law and policy.

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