ACA-E-1 Sexual Harassment Complaint Form
ACA-E-1 Sexual Harassment Complaint Form 8.18.20
Code: ACA-E-1
SEXUAL DISCRIMINATION/HARASSMENT COMPLAINT FORM
Name of complainant:_____________________________________________
Date of complaint:_______________________________________________
Name of person alleged to have discriminated or engaged in harassment: ________________________________________
Date and place of incident or incidents:____________________________________________ ____________________________________________________________________________
Description of misconduct: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
Name of witnesses (if any): ______________________________________________________________________________________________________________________________________________________________________________________________________________
Evidence of harassment, i.e., letters, photos, etc. (attach evidence if possible): ____________________________________________________________________________
____________________________________________________________________________
Any other information:__________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
I agree that all of the information on this form is accurate and true to the best of my knowledge.
Signature:____________________________________
Date:________________________
Adopted: 8/18/20