Anti-Bullying/Anti-Harassment Policy Complaint Form
Name of complainant:
Position of complainant:
Date of complaint:
Name of alleged harasser or bully:
Date and place of incident or incidents:
Description of incident or incidents:
Name of witnesses (if any):
Evidence of harassment or bullying, i.e., letters, photos, etc. (attach evidence if possible):
Any other information:
I agree that all of the information on this form is accurate and true to the best of my knowledge.
Signature:
Date: / /