Get Hfm Boces Form

HFM BOCES Workplace Harassment Complaint Form including Sexual Harassment This form is to be used to document any claim of illegal harassment including sexual harassment which occurs in the workplace. I understand that the HFM BOCES prohibits any individual from retaliating against me for filing a complaint and that I am to notify my immediate supervisor or Title IX Officer that I am a victim of retaliation. Signature of Person Receiving Complaint Date. To ensure that all harassment complaints are managed appropriately effectively and in accordance with the organization s policy harassment complaints including sexual harassment complaints will be recorded using this form* Only those individuals authorized to receive such complaints may do so. If needed guidance can be obtained from the Assistant Superintendent or Title IX Officer. Name of Complainant Department Name s of individual engaging in alleged harassment Please describe the specific incident of harassment alleged* Describe each incident separately including dates times and locations. If you cannot remember exact dates times or locations please provide approximations. Use additional pages if necessary. Are there others who may have witnessed this alleged harassment If so please provide their name s. Page 1 of 2 above If so please provide their name s. Did you tell anyone about your experience after the alleged incident s If yes please provide their name s. by the individual named above If so please provide their name s and state whether they are a witness to this behavior or an individual who has experienced similar behavior Did you speak to the individual named in this report about the alleged harassment If yes what was his or her response Complainant Signature Date Print Name Job Title I attest that the information I have provided is a true and accurate description of my complaint and that I have not willfully or deliberately made false statements. To ensure that all harassment complaints are managed appropriately effectively and in accordance with the organization s policy harassment complaints including sexual harassment complaints will be recorded using this form* Only those individuals authorized to receive such complaints may do so. If needed guidance can be obtained from the Assistant Superintendent or Title IX Officer. Name of Complainant Department Name s of individual engaging in alleged harassment Please describe the specific incident of harassment alleged* Describe each incident separately including dates times and locations. If needed guidance can be obtained from the Assistant Superintendent or Title IX Officer. Name of Complainant Department Name s of individual engaging in alleged harassment Please describe the specific incident of harassment alleged* Describe each incident separately including dates times and locations. If you cannot remember exact dates times or locations please provide approximations. Use additional pages if necessary. If you cannot remember exact dates times or locations please provide approximations. Use additional pages if necessary. Are there others who may have witnessed this alleged harassment If so please provide their name s. Page 1 of 2 above If so please provide their name s.