Company Letterhead
{{company_name}}
{{company_address}}
Phone: {{phone}}
Email: {{email}}
Website: {{website}}
Date
{{date}}
To: HR Department/Management
Subject: Formal Complaint Regarding Harassment
Complainant Information
Name: {{complainant_name}}
Employee ID: {{complainant_employee_id}}
Department: {{complainant_department}}
Contact Number: {{complainant_phone}}
Email: {{complainant_email}}
Respondent Information (if known)
Name: {{respondent_name}}
Employee ID: {{respondent_employee_id}}
Department: {{respondent_department}}
Nature of Harassment
Please describe the nature of the harassment (e.g., verbal, physical, sexual, psychological, cyberbullying):
{{nature_of_harassment}}
Date(s) and Time(s) of Incident(s)
Please provide specific dates and times when the alleged harassment occurred:
{{dates_times_of_incidents}}
Location(s) of Incident(s)
Please specify where the alleged harassment took place (e.g., office, off-site event, virtual meeting):
{{locations_of_incidents}}
Detailed Account of Incident(s)
Please provide a detailed factual account of the incident(s), including what was said or done, and by whom. Be as specific as possible:
{{detailed_account}}
Witnesses (if any)
Please list any witnesses to the incident(s) and their contact information (if known):
{{witness_names_contact}}
Evidence
Do you have any supporting evidence (e.g., emails, messages, photos, videos, documents)? If yes, please describe and attach them:
{{supporting_evidence_description}}
Desired Outcome
What resolution are you seeking from this complaint?
{{desired_outcome}}
Confidentiality and Non-Retaliation Statement
I understand that this complaint will be handled with appropriate confidentiality and that the company has a strict non-retaliation policy for individuals who report harassment in good faith. I understand that failure to provide all relevant information may impact the investigation.
I affirm that the information provided in this complaint is true and accurate to the best of my knowledge.
Signature
_____________________________
{{complainant_signature}}
Date: {{signature_date}}
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