Sexual Harassment Form – Star Hospitality Group

If you believe that you have been subjected to sexual harassment or gender discrimination, you are encouraged, but not required, to complete this form. When you click “Submit” your form will be sent to us and reviewed by our human resources department. No employee will be retaliated against for filing a complaint.

If you are more comfortable reporting verbally or in another manner, please contact Lance Herman ([email protected]) or Wilmary Rodriguez ([email protected]) or call us at 212.661.6148.

Complainant Information

Name(Required)

First Last

Phone(Required)

Select Preferred Communication Method

Phone

In Person

Supervisory Information

Immediate Supervisor’s Name

First Last

Complaint Information

Your complaint of sexual harassment is made about

First Last

Work Location

Relationship To You

Supervisor

Supervisee

Co-Worker

Other (Please Specify)

If other, please specify

Please describe what happened and include as many details as possible

Date(s) Sexual Harassment Occurred (start)

Date(s) Sexual Harassment Occurred (end date)

Is the sexual harassment continuing

Yes

If possible, please list the name and contact information of any witnesses or individuals who may have information related to your complaint:

Have you previously provided information (verbal or written) about related incidents? If yes, when and to whom did you provide information?