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Kings Canyon SD |  E  4119.11, 4219.11, 4319.11  Personnel

Sexual Harassment   

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SEXUAL HARASSMENT COMPLAINT

Prior to completing this form, please read the following:

ωAccurate completion of this form will ensure the immediate and thorough investigation of the complaint.

ωThis form should be submitted to the Assistant Superintendent - Personnel.

ωAn investigation and immediate action will be taken if the district harassment policy has been violated. No action will be taken against an employee for filing a complaint.

ωThe employee filing the complaint will be notified of the outcome of the investigation.

Please complete all sections, sign and date the complaint.

NAME: _________________________________

SCHOOL/DEPARTMENT: ___________________________________

The name of the person this complaint is being filed against: _____________________________________

SCHOOL/DEPARTMENT: __________________________________

Names of witnesses or other persons having knowledge of the conduct complained of:

1. ______________________________________

2. ______________________________________

3. ______________________________________

Employee's Signature _________________________________ Date _____________

Exhibit KINGS CANYON UNIFIED SCHOOL DISTRICT

version: April 19, 1999 Reedley, California