Guidance Care

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Guidance Care

Home
Online Forms
Staff Only
Contact Us
01253 530008

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

Work Location

Phone

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

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

Preferred Method:

Phone

Face-to-face