Sexual harassment is a serious crime that needs to be well documented. It is a sexual crime that involves a complaint against an individual. It can lead to a lawsuit and so it is important for the details to be recorded accurately and truthfully and this form would be handy.
Name of complainant: _____________________________________________________
Status of complainant: _____________________________________________________
Address: ________________________________________________________________
Tel: ____________________________________________________________________
Mobile: __________________________________________________________________
Email: __________________________________________________________________
Name of alleged harasser: __________________________________________________
Relationship: ____________________________________________________________
Status of harasser: ________________________________________________________
Date of alleged incident: ___________________________________________________
Time of the alleged incident: ________________________________________________
Location of the alleged incident: _____________________________________________
Describe the alleged incident: _______________________________________________
_______________________________________________________________________
_______________________________________________________________________
Describe the effects the alleged incident has had on you: __________________________
_______________________________________________________________________
Give details of any person(s) you have reported the alleged incident to:
Name Relationship Date reported
________________________________ _____________________ ____________
________________________________ _____________________ ____________
________________________________ _____________________ ____________
________________________________ _____________________ ____________
________________________________ _____________________ ____________
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