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Anonymous Sexual Harassment Reporting Form
Anonymous Sexual Harassment Reporting Form
(Confidential – for submission to HR & Operations)
Purpose
Guidance Care Ltd is committed to maintaining a workplace that is safe, respectful, and free from all forms of sexual harassment. This form allows employees or others to report any incident or concern, including where they wish to remain anonymous. All reports will be reviewed and appropriate action taken in line with company policy, employment law, and safeguarding duties.
1. Reporting Option
Reporting Option
(Required)
I wish to remain anonymous
I am willing to provide my contact details
Name
Job Role
None
Residential Support Worker
Night Residential Support Worker
Senior Residential Support Worker
Deputy Manager
Registered Manager
Head Office Staff
External
Work Location
None
Head Office
Childrens Homes
Phone
Email
2. Date of Report
Date Completing This Form
DD slash MM slash YYYY
3. Date, Time and Location of Incident
Approximate date of incident
DD slash MM slash YYYY
Approximate Time
Hours
:
Minutes
Location
None
Oakwood House
Coniston House
Willow House
Abbey House
Hambleton House
Head Office
Off Site
Context
e.g. During shift, meeting, training, event, etc
4. People involved
Name
Person(s) whose behaviour caused concern
Name
Person(s) affected or target
Witnesses (If known)
Person(s) affected or target
5. Description of Incident/Concern
Please describe what happened in as much detail as you feel comfortable sharing. Include what was said or done, whether it was a one-off or repeated behaviour, and any relevant context.
Details
(Required)
6. Nature of Behaviour (if known)
Nature
Unwelcome comments or jokes of a sexual nature
Unwanted touching or physical contact
Inappropriate messages, images, or gestures
Repeated or unwanted advances
Sexualised behaviour creating discomfort
Harassment by a third party (e.g., visitor, contractor, professional)
Other (please specify)
7. Impact
How did this make you or others feel? (tick all that apply)
Impact
Intimidated
Humiliated
Distressed
Unsafe
Embarressed
Other (please specify
Optional:
Please describe any ongoing effect or consequence (e.g., avoiding certain staff, changes in wellbeing, missed work, etc.)
8. Support or Follow-up (optional)
If you provided your contact details above:
Would you like someone to contact you?
Yes
No
Preferred Method:
Phone
Email
Face-to-face