________
________
________
________
________
Private and Confidential
Date: ________
RE: Formal Complaint of Workplace Harassment under ________
Dear ________,
§ 1. Purpose of this Letter
1.1 I am writing to make a formal complaint regarding harassment that I have experienced in the course of my employment with ________ (the Employer).
1.2 This complaint follows from, and should be read together with, the discussion we had on ________.
1.3 This complaint is raised in accordance with the Employer's ________ and is made in reliance on the protections afforded to me under the Fair Work Act 2009 (Cth), the Sex Discrimination Act 1984 (Cth), the Racial Discrimination Act 1975 (Cth), the Disability Discrimination Act 1992 (Cth), the Age Discrimination Act 2004 (Cth), the Australian Human Rights Commission Act 1986 (Cth), the model Work Health and Safety laws (including the Work Health and Safety Act 2011 (Cth) and its State and Territory equivalents), and any applicable anti-discrimination legislation of ________.
§ 2. Particulars of the Harassment
2.1 The details of the conduct that is the subject of this complaint are as follows, including (where known) the dates, times, locations, persons involved and any witnesses:
________
2.2 The conduct described above has had the following effect on me and on my ability to perform my duties:
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§ 3. Additional Relevant Information
3.1 In addition to the matters set out above, I would like the Employer to be aware of the following:
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3.2 The following documents, records or other evidence are available to support this complaint:
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§ 4. Action Requested
4.1 I request that the Employer take the following action to investigate and address this matter:
________
4.2 I request that this complaint be investigated promptly, fairly and impartially, in accordance with the Employer's policies and the principles of procedural fairness.
§ 5. Protection from Victimisation
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5.2 I expect that the Employer will take all reasonable steps to ensure that I am not victimised, isolated or otherwise treated unfavourably as a result of raising this matter.
§ 6. Confidentiality
6.1 I request that this complaint, and all information disclosed in connection with it, be treated as strictly confidential and disclosed only to those persons who genuinely need to be involved in its investigation and resolution.
§ 7. Response Sought
7.1 I trust that this complaint will be treated seriously and dealt with promptly and confidentially. I would appreciate a written response, by no later than ________, outlining the steps the Employer intends to take to investigate and resolve this matter.
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7.3 Should you require any further information from me, please do not hesitate to contact me using the details set out above.
Yours faithfully,
________
Signature: ________
Date: ________