HEALTH MODULE
An Instructional Program For Adolescent Activities

How to Recognize and Stop Sexual Harassment

APPENDIX E

Worksheet for Resolving

Sexual Harassment

Alleged sexual harassment situation: (be specific when describing the alleged behavior.)

 

Corrective action requested by the complainant: (even if the complainant does not want any corrective action taken you must ensure that the sexual harassment stops.)

 

Alleged harasser(s) description of the situation:

 

Additional fact finding information: (documentation, witnesses, previous situation)

 

Your appropriate corrective action:

 

Follow-up action:

 

 

Write the names of the internal resource people whom you may contact for additional information or assistance.

Name Office Work Phone

1. ________________________________________________________________

2. ________________________________________________________________

3. ________________________________________________________________

4. ________________________________________________________________

 

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