Sexual Harassment Complaint Form



SEXUAL HARASSMENT COMPLAINT FORMNew York State Labor Law requires all employers to adopt a sexual harassment prevention policy that includes a complaint form to report alleged incidents of sexual harassment. If you believe that you have been subjected to sexual harassment, you are encouraged to complete this form and submit it via email to Central Casting Talent Relations at: ReportHarassment@. You will not be retaliated against for filing a complaint.If you are more comfortable reporting verbally or in another manner, you can also contact Central Casting Talent Relations at (888) 918-8998. Central Casting Talent Relations will complete this form for you, provide you with a copy and investigate the claim.A Microsoft Word version of this complaint form is available on the Central Casting website () and physical copies are available at the Central Casting New York office.For additional resources, visit: programs/combating-sexual-harassment-workplace COMPLAINANT INFORMATIONName: FORMTEXT ?????Work Address: FORMTEXT ?????Work Phone: FORMTEXT ?????Job Title: FORMTEXT ?????Email: FORMTEXT ?????SUPERVISORY INFORMATIONImmediate Supervisor’s Name: FORMTEXT ?????Title: FORMTEXT ?????Work Phone: FORMTEXT ?????Work Address: FORMTEXT ?????COMPLAINT INFORMATIONYour complaint of sexual harassment is made about:Name: FORMTEXT ?????Title: FORMTEXT ?????Work Address: FORMTEXT ????? Work Phone: FORMTEXT ?????Relationship to you: FORMCHECKBOX Supervisor FORMCHECKBOX Subordinate FORMCHECKBOX Co-Worker FORMCHECKBOX Other: ________________Please describe what happened and how it is affecting you and your work. Please use additional sheets of paper if necessary and attach any relevant documents or evidence. FORMTEXT ?????Date(s) incident occurred: FORMTEXT ?????Is the harassment continuing? FORMCHECKBOX Yes FORMCHECKBOX NoPlease list the name and contact information of any witnesses or individuals who may have information related to your complaint: FORMTEXT ?????The last question is optional, but may help the investigation.Have you previously complained or provided information (verbal or written) about related incidents? If yes, when and to whom did you complain or provide information? FORMTEXT ?????Signature: __________________________Date: __________________ ................
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