Sexual Harassment Or Discrimination Complaint Form Page 2
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42. Who or what do you believe was responsible for the alleged sexual harassment or discrimination incident(s)?
3. Accused Name
4. Title
5. Relationship to the Complainant (i.e. supervisor, co-worker, subordinate, etc.)
6. Department
7. Division
8. Section/Unit
9. Work Location
10. Work Phone
11. Home Phone (or other)
12. Describe the alleged sexual harassment or discrimination incident(s). Please specify location(s), date(s) and
time(s) of each occurrence. Use as much detail as possible. Attach additional sheets, if necessary.
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