Training Center Harassment Complaint Form

Name of complainant:

Date you filled out the form:

Phone number of the complainant:

Date and time of alleged incident:

Name of person you believe harassed you:

Where did the incident occur?

Has this happened before?

If the alleged harassment was toward another person, identify that other person:

Describe the incident as clearly as possible. Include a complete description of the events, verbal statements, and any physical contact:

How did you or the person harassed (if not you) react to the harassment?

List any witnesses who were present:

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