APPENDIX C: EMPLOYEE AND COVERED NON-EMPLOYEE COMPLAINT FORM FOR REPORTING SEXUAL HARASSMENT New York State Labor Law requires all employers to adopt a sexual harassment prevention policy that includes a complaint form for employees and covered non-employees to report in writing alleged incidents of sexual harassment. If you believe that you have been subjected to sexual harassment, you are encouraged to complete this form and submit it to the Title IX Coordinator. You will not be retaliated against for filing a complaint. If you are more comfortable reporting verbally or in another manner, the College is still required to follow its sexual harassment prevention policy by investigating the claims as outlined at the end of this form. For additional resources, visit: COMPLAINANT INFORMATION Name: Department: Home Address: Work Phone: Home Phone: Job Email: Select Preferred Communication Method: Email Work Home In person SUPERVISORY INFORMATION Immediate Supervisor’s Name: Title: Work Phone: Department:
APPENDIX C: EMPLOYEE AND COVERED NON-EMPLOYEE COMPLAINT FORM FOR REPORTING SEXUAL HARASSMENT New York State Labor Law requires all employers to adopt a sexual harassment prevention policy that includes a complaint form for employees and covered non-employees to report in writing alleged incidents of sexual harassment. If you believe that you have been subjected to sexual harassment, you are encouraged to complete this form and submit it to the Title IX Coordinator. You will not be retaliated against for filing a complaint. If you are more comfortable reporting verbally or in another manner, the College is still required to follow its sexual harassment prevention policy by investigating the claims as outlined at the end of this form. For additional resources, visit: COMPLAINANT INFORMATION Name: Department: Home Address: Work Phone: Home Phone: Job Email: Select Preferred Communication Method: Email Work Home In person SUPERVISORY INFORMATION Immediate Supervisor’s Name: Title: Work Phone: Department:
Appendix_C_Investigating_and_Resolving_Students_Complaints_2018.docx