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The ________
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Dear Sir/Madam,

RE: FORMAL COMPLAINT OF WORKPLACE HARASSMENT

I, ________, employed by ________ ("the Company") as ________ in the ________ Department since ________, hereby lodge this formal written complaint of harassment which I have been subjected to in the course of my employment. I request that the Company take the necessary steps to investigate and resolve this matter in accordance with its grievance and anti-harassment policies and applicable law.

§1. Particulars of the Person Complained Against

This complaint is made against ________, who holds the position of ________ in the ________ Department ("the Respondent").

§2. Particulars of the Harassment

The Respondent has subjected me to harassment in the following manner:

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§3. Date(s) and Location of the Incident(s)

The said conduct occurred on or about ________ at ________, and where applicable on the following further occasions:

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§4. Witnesses

The following persons witnessed and/or have knowledge of the incident(s) complained of:

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§5. Effect of the Harassment

The aforesaid conduct has created a hostile and intimidating working environment for me and has adversely affected my dignity, well-being and overall work performance in the following respects:

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§6. Supporting Evidence

In support of this complaint, I enclose and rely on the following evidence:

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§7. Prior Steps Taken

I previously reported this matter to ________ on ________, who took the following steps; however, no satisfactory change resulted:

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§8. Legal Basis

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§9. Reliefs Sought

I therefore request that the Company:

1. promptly, impartially and confidentially investigate this complaint in accordance with its policies and the principles of natural justice;
2. take appropriate disciplinary and remedial action against the Respondent to ensure that the harassment ceases and does not recur;
3. take such interim measures as may be necessary to protect me from further harassment, victimisation or retaliation pending the conclusion of the investigation; and
4. communicate to me in writing the outcome of the investigation and the steps taken.

§10. Confidentiality and Protection from Retaliation

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I trust that this complaint will be handled fairly and expeditiously. Should you require any further information or wish to discuss this matter, I may be reached on the contact details above.

Thank you for your attention to this matter. I look forward to your prompt response.

Yours faithfully,

__________________
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Date: ________

Enclosures: ________