New York State Labor Law requires all employers to adopt a sexual harassment prevention policy that includes a complaint form for employees to report 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 Katy McShane, Chief Human Resource Officer, kmcshane@creallc.com. You will not be retaliated against for filing a complaint. If you are more comfortable reporting verbally or in another manner, your employer should complete this form, provide you with a copy, and follow its sexual harassment prevention policy by investigating the claims as outlined at the end of this form.
Complainant Information Name: Work Address: Work Phone: Job Title: Email: Select Preferred Communication Method: (Email, Phone, In person) Supervisor Information Immediate Supervisor's Name: Title: Work Phone: Work Address: Complaint Information 1. Your complaint of sexual harassment is made against: Name: Title: Work Address: Work Phone: Relationship to you: (supervisor; subordinate; co-worker; other)
Please describe the conduct or incident(s) that is the basis of this complaint and your reasons for concluding that the conduct is sexual harassment. Please use additional sheets of paper if necessary and attach any relevant documents or evidence. Date(s) sexual harassment occurred: Is the sexual harassment continuing? (Yes/No) 1. Please list the name and contact information of any witnesses or individuals that may have information related to your complaint: The last question is optional, but may help facilitate the investigation. 1. Have you previously complained or provided information (verbal or written) about sexual harassment at CREA, LLC? If yes, when and to whom did you complain or provide information? If you have retained legal counsel and would like us to work with them, please provide their contact information. Signature: Date:
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