informal-harassment-complaint-form

Western Mennonite School Informal Harassment Complaint Form (yellow form) Brief Description of Problem: (What happened: Describe actions or comments which were unwanted and unwelcomed by you. Include others who were involved.) ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Desired Resolution: (What do you want?) ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Mediator: (Do you have any preference of the person who may help you work out a solution to the problem with the alleged harasser?) ___________________________________________________________________ Choice of Processes: (Complaints filed using this form will be handled using the informal complaint process. If you prefer that this matter be handled in the formal process, please use that form. ________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ Please use additional paper to elaborate on any answer given above.

Signature: ________________________________ Date: ________________ It is the policy of this organization to treat this matter discreetly. However, complete confidentiality cannot be guaranteed due to the nature of an investigation. Thank you for your effort to help keep harassment out of our school.

Received by: _______________________________ Date: __________________ Resolution: ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________ ___________________________________________________________________