Discrimination/sexual Harassment Complaint Form Page 2
ADVERTISEMENT
1
2
3A. Type of complaint:
Discrimination
Harassment
Based on: (please check all that apply)
Age
Color
Disability
Genetic Information
Gender (
)
National Origin
including pregnancy
Race
Religion
Sexual Harassment
Sexual Orientation
Veterans Status
Other: _______________
B. Person(s) who you allege committed the discrimination or harassment:
Name
Title
C. Witness(es):
D. Summary of complaint. (Please provide details such as dates, locations, persons involved
or present, behaviors, comments, other incidents etc. Use additional paper, if needed.)
Page 2 of 3
5/2016
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal