Employee Harassment Complaint Form:
Claimant's Statement:
What exactly occurred or was said? When did it occur, and is it still ongoing? Where did it occur? How often did it occur? How did it affect you?
If "yes," please explain (name of person[s], date, outcome):
How would you like to see this situation resolved?
Are there any notes, physical evidence, potential witnesses, text messages, emails, or other documentation regarding the incident(s)?
I have been instructed that I am free to add or change any of the above details, and I am satisfied that the facts stated above are accurate. I declare that the information given above is correct to the best of my knowledge or belief. A willful false statement is subject to disciplinary action.
This company takes all harassment complaints seriously and will thoroughly investigate this complaint. The information collected may be verified with others who may have knowledge or been witnesses to the acts in question. This company prohibits retaliation against any person who files a complaint or assists in its investigation. This includes intimidation, threats, coercion, or discrimination. Please notify your supervisor or Human Resources manager immediately if any attempt at retaliation is made.
Employee Harassment Complaint Form Instructions
Various laws prohibit harassment and discrimination of employees, job applicants, and visitors on the basis of sex (including sexual orientation and gender identity), gender, age, race, religion, national origin, pregnancy, or disability. Multiple court decisions and agency guidance have clarified that employers must take reasonable steps to investigate and correct any claim of harassment. Employers can use the Employee Harassment Complaint Form to provide to workers who believe they have been harassed and would like to file a complaint, triggering an internal investigation.

Why its Important
When employers handle harassment complaints properly, it helps everyone involved feel that the issue will be investigated promptly and fairly. To start the process, the accuser can complete the clear and easy-to-use Employee Harassment Complaint Form to present any important information.

Instructions for Use
The Employee Harassment Complaint Form is the first step in initiating a harassment investigation. The form needs to be completed in full by the accuser with only truthful and accurate information for the investigator to understand the issue at hand. Once completed, the form should be returned to a manager, supervisor, or Human Resources officer. If more than one incident has occurred, each incident can be reported on a separate form.

When to Use
At the first mention of an act of harassment, the Employee Harassment Complaint Form needs to be provided to the accuser right away. Upon receiving the completed form, the investigating party should immediately take steps to investigate and correct the alleged harassment.

Retention Requirements
Under federal law, the minimum retention period for any documentation of an employment action is one year from the date of the action. Federal contractors need to retain those records for at least two years, depending on the laws that apply to them. Some state laws may have extended retention periods when it comes to employment action documents. For example, a completed Employee Harassment Complaint Form could be considered a corrective action document to support an employment action. Corrective action documents do not have specific retention dates. However, employers should keep them with any corresponding employment action documents for the required retention period. Check your state's anti-discrimination laws to determine the statute of limitations on harassment claims, and ensure that allegations are retained for at least that length of time.
