REPORT OF HARASSMENT  

Name of Complainant:     

 

For Students, School Attending:     

 

For Employees, Position and Location:     

 

Address, Phone Number and Email Address:     

 

   

 

Date(s) of Alleged Incident(s) of Harassment:     

 

   

 

Name of person(s) you believe harassed you or others     

   

 

If the alleged harassment was toward another, please identify that person: 

   

   

Please describe in detail the incident(s) of alleged harassment, including where and when the incident(s) occurred.  Please note any witnesses that may have observed the incident(s).  Please include a description of any past incidents that may be related to this complaint.  Attach additional pages if necessary. 

I certify that the information provided in this report is true, correct and complete to the best of my knowledge. 

   

Signature of Complainant Date  

Complaint Received By:     

        (Principal or Compliance Officer) Date 

 

GILES COUNTY PUBLIC SCHOOLS  

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