Cassadaga, NY · Chautauqua County
Model Complaint Form for Reporting Sexual Harassment
This model form lets Village of Cassadaga employees report alleged sexual harassment to an appropriate person identified in the document.
What this form is
Employees who believe they have experienced sexual harassment are encouraged to complete this form and submit it to an appropriate person, such as the Supervisor, Mayor, Fire Chief, President, or a Village Board Member. It asks for contact and work information, details about the alleged harassment, dates, witnesses, and any prior reports. The form allows additional sheets and relevant evidence to be attached.
Who needs it
An employee who wants to report alleged sexual harassment to an appropriate person listed on the form can use this complaint form.
How to submit it
Submit the completed form to an appropriate person listed on it: the Supervisor, Mayor, Fire Chief, President, or a Village Board Member. Attach any relevant documents or evidence if applicable.
About notarization
This form is signed and dated without a notary; relevant documents or evidence may be attached, but the form does not say attachments must be notarized.
How to submit this form
- 1
Download The Form
Download the Model Complaint Form for Reporting Sexual Harassment.
- 2
Complete The Form
Provide the requested complainant, supervisor, incident, date, witness, and prior-report information.
- 3
Gather Attachments
Attach any relevant documents or evidence, using additional sheets of paper if necessary.
- 4
Sign And Submit
Sign and date the form, then submit it to an appropriate person listed on the form.
Frequently asked questions
- Do I need a notary for the Sexual Harassment Complaint Form?
- No. The form asks for a signature and date, but has no notary block. Relevant documents or evidence may be attached; the form does not say attachments must be notarized.
- How do I submit the Sexual Harassment Complaint Form?
- Submit it to an appropriate person listed on the form: the Supervisor, Mayor, Fire Chief, President, or a Village Board Member. You may attach relevant documents or evidence.
- What information does the complaint form ask for?
- It asks for complainant and supervisor information, details about the alleged harassment, dates, whether it is continuing, possible witnesses, and information about any prior related complaints.