Report Workplace Harassment Safely & Anonymously

Enable employees to anonymously report harassment or discrimination incidents with this secure, compliance-ready form template for HR teams.

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Anonymous Workplace Harassment & Discrimination Tip Submission Form

Type of incident being reported

If 'Other,' please specify the t

· · ·

Department or area where the inc

Submit

The Anonymous Workplace Harassment & Discrimination Tip Submission Form empowers employees to safely report incidents of harassment, discrimination, or misconduct without fear of retaliation. Designed with anonymity at its core, this template allows reporters to describe the incident in detail, identify the department or location, and upload supporting evidence — all without disclosing their identity unless they choose to do so.

This form is ideal for HR departments, compliance officers, legal teams, and organizational leadership committed to maintaining a safe and equitable workplace. It captures critical details such as the type of incident, roles of individuals involved, witness information, prior reporting history, and the reporter's desired resolution — giving your compliance team everything needed to investigate thoroughly and act decisively.

By deploying this template, organizations demonstrate a proactive commitment to workplace safety, legal compliance, and employee wellbeing. The structured format ensures consistent data collection across all submissions, streamlining the review process while protecting the dignity and confidentiality of everyone involved. Get started today and build a culture of accountability and trust.

3 Pages

20 Questions

~7min To complete

Free No credit card needed

Field types Single Choice ×5 Long Text ×4 Short Text ×3 Dropdown Date Time Picker Yes / No File Upload Multiple Choice Email termsandconditions

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 About the Incident 7 questions

Incident Details

This form is completely anonymous. Do not include your name or any personally identifying information unless you choose to do so. All submissions are reviewed by the designated compliance team.

1 Type of incident being reported * Single Choice

2 If 'Other,' please specify the type of incident Short Text

3 Department or area where the incident occurred * Dropdown

4 Location where the incident took place (e.g., office floor, break room, parking lot, virtual meeting) Short Text

5 Date of the incident (or approximate date) * Date

6 Approximate time of the incident Time Picker

7 Is this an ongoing issue? * Single Choice

Page 2 Incident Description 8 questions

What Happened

1 Please describe the incident in as much detail as possible. Include what was said or done, the sequence of events, and any context you feel is relevant. * Long Text

2 Role or title of the person(s) involved (do not include names if you wish to remain anonymous) Short Text

3 How many individuals were involved in the reported behavior? Single Choice

4 Were there any witnesses to the incident? Yes / No

5 If yes, please describe who witnessed the incident (by role or title only, if staying anonymous) Long Text

6 Have you previously reported this issue through any channel? * Single Choice

7 If yes, please describe what happened when you reported it and to whom Long Text

8 Upload any supporting evidence (screenshots, documents, photos, recordings) File Upload

Page 3 Desired Outcome & Follow-Up 5 questions

Resolution & Contact Preferences

1 What outcome would you like to see from this report? Multiple Choice

2 Is there anything else you would like the compliance team to know? Long Text

If you would like to receive follow-up communication regarding this report, you may optionally provide a contact method below. This is entirely voluntary and will be kept confidential.

3 Would you like to be contacted about this report? Single Choice

4 Confidential contact email (optional) Email

5 I confirm that the information provided in this report is truthful and accurate to the best of my knowledge. I understand that filing a knowingly false report may be subject to disciplinary action. * termsandconditions

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.