[{"id":"c49d276b-1f29-41e1-83f3-2963b29c3735","order":1,"text":"WORKPLACE HARASSMENT COMPLAINT FORM","fontSize":"20","textAlign":"center","bold":true,"underline":true,"marginBottom":"6","cflou":false,"active":true},{"id":"fd808863-897b-4b00-83fc-6038b7894fb2","order":2,"text":"CONFIDENTIAL — TO BE COMPLETED AND SUBMITTED TO HUMAN RESOURCES","fontSize":"12","textAlign":"center","bold":true,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"3f213961-6121-46a5-afbf-e973b7242144","order":3,"text":"This form is provided to enable any employee, applicant, or other covered individual to report conduct believed to constitute harassment, discrimination, or related misconduct in the workplace. The information collected will be used to initiate a prompt, thorough, and impartial investigation. The Company prohibits retaliation against any individual who, in good faith, reports such conduct, participates in an investigation, or opposes conduct reasonably believed to be unlawful.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"2693e6ef-8cb1-41a6-96c9-e265f53b191c","order":4,"text":"1. COMPLAINANT INFORMATION","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"marginTop":"10","sectionNum":"S01"},{"id":"9d3238b2-3c43-4131-92f9-15d64a3075dc","order":5,"text":"Name of Complainant: [Full legal name].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"fa0d43cc-28e6-47af-b524-72e77cd454dc","order":6,"text":"Job Title / Position: [Job title].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"9d0fd809-875d-4cca-aaea-491feb9e0ba9","order":7,"text":"Department / Division: [Department].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"4dca141e-ff9e-4027-b95e-256cf5ff72f8","order":8,"text":"Work Location: [Work location or facility].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"88ebcd5a-8156-4a8f-a8e4-d1149d523b4a","order":9,"text":"Direct Supervisor / Manager: [Supervisor name].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"6077d4a8-f0e3-4cb5-82f3-70f7a85ab370","order":10,"text":"Telephone: [Phone number] — Email: [Email address].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"e606448f-7c09-4a82-b5e9-db80d5f3d5e3","order":11,"text":"Date of Hire: [Date of hire].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"f30d0df1-dfac-46bc-a025-04ebface09c8","order":12,"text":"2. PERSON(S) AGAINST WHOM THE COMPLAINT IS MADE","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S02"},{"id":"2b3754df-9d3e-4c80-b073-997fa258a833","order":13,"text":"This complaint is made against [one / more than one] individual(s).","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"29dc29ab-be39-4c65-abc9-658c61349416","order":14,"text":"Name of Respondent: [Respondent full name].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"e59a6980-d166-4402-a66f-d38ee9ea2ee6","order":15,"text":"Respondent's Title / Position: [Respondent title].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"345f80b6-9d6a-49b0-b501-889728dff87b","order":16,"text":"Respondent's Department: [Respondent department].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"fbf47aa4-3d3b-4c38-adb1-060144c9eb42","order":17,"text":"Relationship of Respondent to Complainant: [Relationship].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"3c3db3e9-1787-4d81-8c09-abef245eee81","order":18,"text":"Additional Respondent(s): [Names, titles, and relationships of any additional persons].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"5af9115e-ca53-49d4-93f2-d87356decbff","value":"one","type":"remove","operator":"="}]},{"id":"be451c28-7dbb-4b5c-89bc-e03dc6352492","order":19,"text":"3. NATURE AND BASIS OF THE ALLEGED HARASSMENT","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S03"},{"id":"fb8d9422-0ae6-4ec3-a594-e1c6f0cb5b4d","order":20,"text":"The conduct complained of is alleged to constitute harassment of the following type: [Type of harassment].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"ab96ba02-7958-4f6e-ae5b-2d444fc55290","order":21,"text":"The Complainant believes the conduct was based, in whole or in part, on the following protected characteristic(s) or status: [Protected basis].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"52bed6d1-6417-4ee8-af1c-f9c78a9b6aa9","order":22,"text":"Description of the protected basis (if other or additional): [Specify the protected characteristic].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"a14f7767-1e06-4b3b-9d91-36fcd9a68c22","value":"Other (specify)","type":"add","operator":"="}]},{"id":"9a1f047a-49c0-4aa5-9645-0924a39be115","order":23,"text":"The Complainant alleges that the conduct described herein was unwelcome and that it had the purpose or effect of unreasonably interfering with the Complainant's work performance or of creating an intimidating, hostile, or offensive working environment, and/or that submission to or rejection of such conduct was used as a basis for an employment decision affecting the Complainant.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"ee1ef975-ee80-4459-90ef-af5abe8b36d3","order":24,"text":"4. FREQUENCY AND DURATION OF THE CONDUCT","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S04"},{"id":"b097ce08-dfc3-4f3e-8937-2dc5c83abded","order":25,"text":"The conduct complained of consisted of [a single incident / repeated or ongoing conduct].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"fe5e88be-dcdb-451c-ae98-85be2aaf4a6c","order":26,"text":"Date of the incident: [Date of the incident]. Approximate time: [Approximate time]. Location: [Location where it occurred].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"9ef60308-bc02-4149-8a0c-c6cf86bf9e1a","value":"repeated or ongoing conduct","type":"remove","operator":"="}]},{"id":"37828f65-8baa-49c0-876a-4ebc2755809d","order":27,"text":"The conduct began on or about [Approximate start date] and [is ongoing / last occurred on (date)]. It occurred with the following approximate frequency: [Frequency, e.g. weekly]. The conduct primarily occurred at the following location(s): [Location(s)].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"9ef60308-bc02-4149-8a0c-c6cf86bf9e1a","value":"a single incident","type":"remove","operator":"="}]},{"id":"4905cfcc-2e42-4e89-983f-0fb51ca209d0","order":28,"text":"5. DETAILED DESCRIPTION OF THE INCIDENT(S)","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S05"},{"id":"d3bee580-67e1-4b2b-8ca3-94ca37a8e54e","order":29,"text":"Set forth below, in the Complainant's own words and in as much detail as possible, a factual account of what occurred, including what was said or done, by whom, in what sequence, and the surrounding circumstances. The Complainant should describe each incident separately and chronologically where practicable, and should avoid characterizations in favor of specific facts.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"32e39a19-ff3d-4228-afa6-9abd4aa2bdbc","order":30,"text":"[Detailed factual narrative of the conduct]","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"aa5e6b96-c6be-4378-87a1-9724e3bc3a9a","order":31,"text":"6. WITNESSES","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S06"},{"id":"31b779c6-7822-4d34-a2c8-0f6d46428d3f","order":32,"text":"There [were / were no] individuals who witnessed, overheard, or have direct knowledge of the conduct described above.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"23f19d12-7fdc-43e7-b1c9-bc9b5f727d1b","order":33,"text":"Identification of witnesses (names, titles, and contact information, if known): [Witness names and contact details].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true,"displayConditions":[{"field":"279b0baa-5b9e-4614-91f0-4fa0aa198185","value":"were no","type":"remove","operator":"="}]},{"id":"28b1166e-8b77-4f14-aa14-108b204ff4d8","order":34,"text":"Summary of what each witness observed or has knowledge of: [What each witness observed].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"279b0baa-5b9e-4614-91f0-4fa0aa198185","value":"were no","type":"remove","operator":"="}]},{"id":"1bb51a23-0e2c-4933-8307-1680cc268d3b","order":35,"text":"7. PRIOR REPORTS OR COMPLAINTS","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S07"},{"id":"5d70b956-8809-4328-9304-12229c36ffd7","order":36,"text":"The Complainant [has / has not] previously reported this or related conduct to the Company or any other person or authority.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"8a748109-5d6f-4d8a-a1cb-527181cc9e25","order":37,"text":"Details of any prior report (to whom, date, and outcome, if known): [To whom reported, date, and outcome].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"b18e34de-dd47-4779-9660-f66bcb77e885","value":"has not","type":"remove","operator":"="}]},{"id":"c5be89ac-1f44-4cc1-a3a0-24466e540e0b","order":38,"text":"8. SUPPORTING DOCUMENTATION AND EVIDENCE","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S08"},{"id":"2434d6ce-798e-4edb-99fb-960f3587fe76","order":39,"text":"The Complainant [is providing / is not providing] supporting documentation or physical evidence in connection with this complaint.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"400843d5-7795-4516-8f85-a6e946516f34","order":40,"text":"Description of evidence submitted or available (e.g., emails, text messages, photographs, recordings, notes, or other records): [Describe the evidence].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"68370278-8b4f-4dac-8339-0213a4136a34","value":"is not providing","type":"remove","operator":"="}]},{"id":"3a432419-ba15-4930-a26b-d42874cdcf28","order":41,"text":"9. EFFECT ON THE COMPLAINANT","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S09"},{"id":"3d32297d-06b2-4936-ba09-6d77b539a944","order":42,"text":"Description of the effect the conduct has had on the Complainant, including any effect on the Complainant's work, working conditions, terms of employment, or wellbeing: [Describe the impact of the conduct].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"b742db9f-1cc5-4143-aeff-8038ef2ea838","order":43,"text":"10. CONCERNS REGARDING RETALIATION","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S10"},{"id":"4a207a60-460e-4d32-9a18-c8668be52dda","order":44,"text":"The Complainant [has / does not have] specific concerns regarding possible retaliation for making this complaint.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"1c67a14a-fd8b-41b0-82f0-fb21ea1afe0e","order":45,"text":"Description of any retaliation concern or any adverse action already experienced: [Describe any retaliation concern or adverse action].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"73681ab8-2a9b-4432-927d-6c0690438453","value":"does not have","type":"remove","operator":"="}]},{"id":"4b1d055e-fee2-4880-a26d-eb33c419ebba","order":46,"text":"11. RESOLUTION SOUGHT","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S11"},{"id":"88e7ea3d-f89f-4fa2-a342-4881ad569560","order":47,"text":"The Complainant requests the following action or resolution: [Resolution or remedy sought].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"e6b40801-99ad-4630-8b86-41bf3df71252","order":48,"text":"Additional remedy or comment: [Specify any additional remedy requested].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true,"displayConditions":[{"field":"f562d065-4ac6-4715-90b1-fc190cfe270c","value":"Other (specify)","type":"add","operator":"="}]},{"id":"28753cb3-f73c-45a3-99ab-bd155b1cf312","order":49,"text":"12. ACKNOWLEDGMENTS AND CERTIFICATION","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true,"sectionNum":"S12"},{"id":"db4b58e5-4f60-4a8c-b55a-e841d2c96d55","order":50,"text":"Good-Faith Certification. The Complainant certifies that the statements made in this complaint are true and accurate to the best of the Complainant's knowledge, information, and belief, and that this complaint is submitted in good faith and not for any improper purpose.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"0edfff61-a8c4-4f14-a7ef-2abe44bc8a21","order":51,"text":"Anti-Retaliation Assurance. The Complainant understands that the Company strictly prohibits retaliation against any individual who, in good faith, reports suspected harassment or discrimination, participates in an investigation, or opposes conduct reasonably believed to be unlawful, and that any retaliation should itself be reported immediately to Human Resources.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"4f342d56-9107-4ac7-a403-bef04df08ed0","order":52,"text":"Confidentiality. The Complainant understands that the Company will treat this complaint as confidential to the extent reasonably practicable and consistent with conducting a thorough and impartial investigation, but that complete confidentiality cannot be guaranteed, as disclosure of certain information may be necessary to investigate the matter and to take appropriate corrective action.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"4f806d16-744f-4aa1-b64d-5fa29b30f1c8","order":53,"text":"Cooperation. The Complainant agrees to cooperate fully and honestly in any investigation arising from this complaint and to provide such additional information as may reasonably be requested.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"f52e123b-f4be-429d-873d-f7a1fda94989","order":54,"text":"Preservation of Statutory Rights. The Complainant understands that submitting this internal complaint does not limit, waive, or replace any right the Complainant may have to file a charge or complaint with a government agency, including the U.S. Equal Employment Opportunity Commission (EEOC) or the applicable state or local fair employment practices agency, and that such agencies generally impose strict deadlines for filing.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"8","cflou":false,"active":true},{"id":"3771d9fc-ea27-4918-a40d-b7eedf029a89","order":55,"text":"No Alteration of Employment Status. The Complainant understands that this complaint and any resulting investigation do not alter the at-will nature of employment, where applicable, and do not constitute a contract or guarantee of any particular outcome, term, or condition of employment.","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"095fbda2-1890-4a5f-afc2-de0f748586fb","order":56,"text":"Signature of Complainant: ____________________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true,"marginTop":"10"},{"id":"dcb2729b-57de-4688-b8bf-b9ac36cfac1e","order":57,"text":"Printed Name: [Full legal name].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"79a35b0f-9cf3-4809-ba4e-c8413c094fb5","order":58,"text":"Date: [Date of signature].","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"20","cflou":false,"active":true},{"id":"17ef3485-23d8-43ab-a592-82c64d871234","order":59,"text":"FOR HUMAN RESOURCES USE ONLY","fontSize":"16","textAlign":"left","bold":true,"underline":false,"marginBottom":"10","cflou":false,"active":true},{"id":"0eaab7f3-2b4c-4ef8-b9b5-faca5dedfc65","order":60,"text":"Date Complaint Received: ____________________ Received By: ____________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"dbc86a9d-f2bd-4d5e-bc43-c94fb72c1ef5","order":61,"text":"Complaint Reference Number: ____________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"77db6e7d-8d83-4499-aad9-aa5f22301648","order":62,"text":"Date Investigation Initiated: ____________________ Assigned Investigator: ____________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"6","cflou":false,"active":true},{"id":"cf9ae4ad-aea5-40e3-a000-5e428907a927","order":63,"text":"Notes: ________________________________________________________________________","fontSize":"14","textAlign":"left","bold":false,"underline":false,"marginBottom":"0","cflou":false,"active":true}]