Workplace Harassment Investigation Form printable pdf download

Workplace Harassment Investigation Form

Name of investigator:

Date of investigation:

A. Background Information

Who are the people involved? Are they workers as defined by Occupational Health and

Safety Act (OHSA)? Who reported and when?

1. Name of person who reported workplace harassment

2. If not the same person as above, name of person who allegedly experienced

workplace harassment

3. Date complaint/concern raised and how

4. Name of worker(s) (complaining or possibly exposed to workplace harassment):

Position/Department

5. Name of respondent(s) (alleged harasser); Position/ Department

If not a worker – provide details

B. Investigation Plan

Plan and conduct the investigation:

1. Obtain the worker(s) concerns of harassment in writing, if possible. Assistance

should be provided in completing the form where necessary.

2. An investigator needs to interview the worker who allegedly experienced workplace

harassment and the alleged harasser (if a worker of the employer). If the alleged

harasser is not a worker of the employer, the investigator should make reasonable

efforts interview him or her.

3. Make a list of possible relevant witnesses. The worker who allegedly experienced

workplace harassment and the alleged harasser should be asked for names of any

relevant witnesses.

4. Interview relevant witnesses. Ask specific questions about what they have observed,

are aware of or have personally experienced. If the witnesses are not workers of the

employer, the investigator should make reasonable efforts to interview those

witnesses.

5. Collect and review relevant documents from the worker, alleged harasser, witnesses

and the employer.

Workplace Harassment Investigation Form