FORMAL COMPLAINT OF WORKPLACE HARASSMENT
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Email: ________
Phone: ________
Date: ________
Delivered by: ________
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Email: ________
RE: Formal Complaint of Workplace Harassment
Dear ________:
§ 1. Purpose of This Communication. This letter constitutes a formal, written complaint of workplace harassment that I have experienced in the course of my employment with ________ (the “Company”). I am submitting this complaint to place the Company on notice and to request that it discharge its legal obligation to promptly investigate and remediate the conduct described below. I respectfully request that this matter be treated as a formal complaint pursuant to the Company’s anti-harassment policy and applicable law, including Title VII of the Civil Rights Act of 1964, 42 U.S.C. § 2000e et seq., and the applicable anti-discrimination and anti-harassment statutes of the State of ________.
§ 2. My Employment Information.
- Employee Name: ________
- Position/Title: ________
- Department/Location: ________
- Date of Hire: ________
- Direct Supervisor: ________
§ 3. Identity of the Alleged Harasser and Onset of Conduct. The individual engaging in the conduct complained of is ________, whose title and relationship to me is ________. The harassing conduct began on or about ________ and, to date, has ________.
§ 4. Nature of the Harassment. The conduct I have experienced constitutes sexual harassment. I believe this conduct is unwelcome, is based on a protected characteristic, and has created a hostile, intimidating, or offensive work environment and/or has otherwise affected the terms and conditions of my employment.
§ 5. Specific Incidents. The following is a description of the relevant incidents, including, where known, the date, time, location, persons present, and a factual account of what occurred:
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§ 6. Prior Reports. I have already raised these incidents and this pattern of conduct with the following individual(s) on the date(s) indicated, but to my knowledge no effective corrective action has been taken: ________
§ 7. Supporting Evidence. I am in possession of, or aware of, the following evidence relating to the conduct described above:
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§ 8. Witnesses. The following individuals witnessed certain of the incidents described above and have indicated a willingness to provide statements:
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§ 9. Additional Information. I wish to make the Company aware of the following additional information relevant to this complaint:
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§ 12. Reservation of Rights. Nothing in this letter shall be construed as a waiver of, and I expressly reserve, all rights and remedies available to me under federal, state, and local law, including the right to file a charge with the U.S. Equal Employment Opportunity Commission and/or the applicable state or local fair employment practices agency, and to pursue any other available legal remedy.
§ 13. Request for Response. I am available to provide any additional information you may require in furtherance of your investigation and request a written response on or before ________. Thank you for your prompt attention to this serious matter.
Sincerely,
________
Signature: ____________________________
Date: ________
cc: ________