Office Bullying and Harassment Policy Volumn 2013 | Page 6
Dr. S. H. Lee Medical Centre & Sunray Outpatient Aesthetic Clinic
Workplace bullying and harassment
complaint form
Name and contact information of complainant
Name of alleged bully or bullies
Personal statement
Please describe in as much detail as possible the bullying and harassment incident(s),
including:
•
the names of the parties involved
•
any witnesses to the incident(s)
•
the location, date, and time of the incident(s)
•
details about the incident(s) (behaviour and/or words used)
•
any additional details that would help with an investigation
Attach any supporting documents, such as emails, handwritten notes, or photographs.
Physical evidence, such as vandalized personal belongings, can also be submitted.
Signature
Date