Policy DKB - Sexual Harassment Exhibit 1

Policy DKB- Sexual Harassment Exhibit 1 (PDF)

Issue Date November 18, 2009

Report of Sexual Harassment

This form shall be maintained as confidential by the District within the limitations outlined in policy. 

Name:                                                                      

Home Telephone Number:                                      

Street Address:                                                        

Employment Position:                                             

School:                                                                     

Street Address:                                                        

The particulars are (if additional space is needed, attach extra sheets): __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Persons Involved: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Description of dates, places and nature of sexual harassment: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Witnesses (if any): ____________________________________________________________________________________________________________________________________________________________

                                                                        ___________________________

                                                                        Signature of Complaining Person