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