As Per Governor Kemp's Executive Order 01.14.19.02, each executive branch agency shall promptly review all complaints of sexual harassment and/or retaliation and immediately report any complaint made directly to the Office of the State Inspector General utilizing the form below.
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Complainant Information (individual who allegedly experienced sexual harassment or retaliation)
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| Prefix |
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| First Name |
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| Last Name |
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| Phone Number |
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| Email Address |
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| Job Title |
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| Facility |
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| Facility Work Address |
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| Respondent Information (individual whom the complaint is about) |
| Prefix |
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| First Name |
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| LastName |
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| Phone Number |
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| Job Title |
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Relationship to Complainant
If you need to select multiple options, please select "OTHER" and describe in the box below
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| Complaint Information |
| Date of occurrence |
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| Have you discussed this issue with your supervisor? |
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List specific problem(s)/issue(s)
(Descibe what happened, when and where, how your employment has been unfavorably affected, and indicate names of others involved. Attach any supporting documentation) | |
| Has any conduct been reported to a law enforcement agency? |
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Are there concerns that the agency cannot fairly or impartially investigate the complaint?
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