Sherburne, NY · Chenango County
Complaint Form for Reporting Sexual Harassment
Employees who believe they experienced sexual harassment can use this form to report the incident to the Village of Sherburne’s appointed trustees.
What this form is
This form lets an employee report alleged sexual harassment and request an investigation under the employer’s sexual harassment prevention policy. It asks for contact and supervisor information, details about the alleged conduct and dates, and names of potential witnesses. The employee may also provide related documents or evidence and answer optional questions about prior complaints or claims.
Who needs it
An employee who believes they have experienced sexual harassment may complete this form and submit it to the appointed Village Board Trustee(s).
How to submit it
Submit the completed form to the appointed Village Board Trustee(s) for sexual harassment. The document does not provide an address, email, portal, or fee information.
About notarization
This document is signed and dated without a notary; the signer may attach additional pages and relevant documents or evidence, but no attachment is identified as sworn or notarized.
How to submit this form
- 1
Download The Form
Download the Village of Sherburne Complaint Form for Reporting Sexual Harassment.
- 2
Complete The Form
Provide your information, describe the alleged conduct and dates, and answer the questions that apply.
- 3
Gather Attachments
Add extra pages if needed and attach relevant documents or evidence.
- 4
Submit To The Village
Submit the completed form to the appointed Village Board Trustee(s) for sexual harassment.
Frequently asked questions
- Do I need a notary for the Sexual Harassment Complaint Form?
- No. The form asks the complainant to sign and date it, but it has no notary block. Additional pages and relevant documents or evidence may be attached without a notary requirement stated on the form.
- How do I submit the Sexual Harassment Complaint Form?
- Submit the completed form to the appointed Village Board Trustee(s) for sexual harassment. The form does not list an address, email, or online submission portal.
- What information does the complaint form ask for?
- It requests the complainant’s contact and job information, supervisor details, information about the person complained against, a description of the conduct and dates, and potential witnesses. Some questions are optional.
- Can I include supporting material with my complaint?
- Yes. The form invites complainants to use additional sheets if needed and attach relevant documents or evidence.