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Complaint Form
Complaint of Sexual Harassment to be reported to PCMM Internal Complaints Committee (ICC)
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Name of the Complainant
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Your answer
Email of the Complainant
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Your answer
Phone Number of the Complainant
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Your answer
Status of the Complainant
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Student
Teaching Staff
Non-Teaching Staff
Other
Name the person(s) engaged in the alleged act(s) of harassment.
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Your answer
Please describe the specific act(s) alleged.
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Your answer
Place(s) the alleged act(s) took place
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Your answer
Date of the alleged act(s)
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MM
/
DD
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YYYY
Approximate Time of the alleged act(s)
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Time
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AM
PM
Is there any witness of the alleged act(s)?
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Yes
No
Detail of witness of the alleged act(s).
Your answer
Additional Information and Comments (if any)
Your answer
I do hereby declare that the allegation lodged here is not frivolous. All other information furnished here are true to the best of my knowledge
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