Workplace Harassment Complaint Form

OHS laws require employers to provide a clear and accessible method for workers to submit complaints about the workplace harassment they experience or witness. In addition to being required by law, incident reporting protocols are critical to ensure a full and fair investigation of the complaint. Here’s a Model Harassment Complaint template that you can adapt to ensure effective reporting. Designate a person or department to receive complaints and provide for an alternative recipient that workers can resort to when the primary designate is involved in the alleged harassment.

Instructions: Please complete all of the items of this form so that we can investigate, determine what happened and take appropriate actions to respond to the incident. Attach additional pages, if necessary. ABC Company will keep the information you provide confidential and not use or disclose except for purposes of investigating the incident and for uses and disclosures required by law. We also ask you to maintain confidentiality and not disclose the details of this report except to those investigating the incident. If necessary, support, counseling and guidance will be made available to you in accordance with the ABC Company Workplace Harassment Policy.