Internal Complaint form

    Internal Complaint Form

    Full Name:

    Employee No / Student Register No:


    Departmemt / Shift:

    Date of Incident:

    Time of Incident:

    Perosn(s) you allege committed the sexual Harassment : Name

    Please describe the incident in detail, including your reaction to the incident:

    Person(s) who witnessed the incident, if any:

    I confirm that the information given in this form is true, complete and accurate, and I have stated the facts to best of my ability and knowledge.

    Employee Signature: