Home Workplace bullying and harassment – Complaint form Workplace bullying and harassment – Complaint form BACKGROUNDHiddenComplaint IDHarassment refers to any unwelcome or offensive conduct that has had, or might reasonably be expected to have, the effect of (1) offending, humiliating, embarrassing, or intimidating another person(s), and (2) creating an intimidating or hostile work environment and/or unreasonably interfering with another person(s)’ ability to carry out their functions at work. Harassment may occur through words (written or spoken), gestures, or actions, and can be directed at one person or several people, at any level. There are different types of harassing behaviors, including abuse of authority, bullying/mobbing, sexual harassment, and discrimination. Any person of any gender identity may be the victim of any type of harassment. Bullying is repeated offensive, cruel, intimidating, insulting, or humiliating behavior that undermines an individual or group of individuals. Bullying may be physical, verbal, visual, or written. Before completing this form, it is recommended that you understand what harassment and bullying are." You should complete and submit this form to IITA’s Internal Audit Unit (IAU) if your complaint meets the above definition of bullying and harassment. Completing this is anonymous and will only go to IITA’s Internal Audit Unit (IAU) who will handle the complaint. The more information you complete the better the IAU can assist you, but no field is mandatory; if you do not want to complete a field, you do not have to.PERSONAL DETAILS (of the person making this complaint)Full Name Employee Number PhoneEmail Are you the person who was allegedly bullied? Yes No PERSONAL DETAILS (of the person who is alleged to have been bullied)Full Name Employee Number PhoneEmail PERSON ALLEGED TO BE RESPONSIBLE FOR BULLYINGFull Name Employee Number Position / Designation Section Working relation with person bullied Manager / Supervisor Co-worker Subordinate BULLYING BEHAVIOURSFrequent yelling or verbal abuse alone or in the presence of others Yes No DateDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Is it in writing? Yes No Persistent and unjustified criticisms and or repeated threats of disciplinary action Yes No DateDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Is it in writing? Yes No Spreading gossip, malicious rumour, or innuendo about a person Yes No DateDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Is it in writing? Yes No Inappropriate disclosure of personal/confidential information about a person to others Yes No DateDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Is it in writing? Yes No Ridicule or humiliate a person through inappropriate gestures, sarcasm, criticism or insults, or offensive objects or images (including cyber bullying) Yes No DateDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Is it in writing? Yes No Engaging in initiation activities or practical jokes that have the potential to physically harm, belittle, or humiliate Yes No DateDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Is it in writing? Yes No Excluding or isolating a person from a workplace Yes No DateDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Is it in writing? Yes No Deliberately altering work arrangements to inconvenience a particular employee or group of employees Yes No DateDay12345678910111213141516171819202122232425262728293031Month123456789101112Year2025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Is it in writing? Yes No Details / Particulars of alleged bullying incidents (Who, what, when, where and how)WITNESSES (please provide details of witnesses to the alleged bullying)Full Name (Witness 1) Phone no / Email (Witness 1) Full Name (Witness 2) Phone no / Email (Witness 2) DIRECTORATE / UNIT / SECTION MANAGEMENTHave you reported this matter to anyone else? Yes No Who did you report the matter to? When did you make the report, and what has happened since the report was made?Attachments (e.g. Emails, diary entries, photographs, etc.) Drop files here or Select files Max. file size: 512 MB. DeclarationConsent I declare that the information in this complaint is true and correct to the best of my knowledge.
