Belte r r a Cor p or at ion S afety M an ual D oc I D C H S M BE L 2 0 1 7 Pa g e 5 07 of 53 8 Workpl ace Vi ol en ce Bu ll y i ng Harass ment Resp on se t o C ompl ain t F orm Doc u m e n t Identif icat ion F R M 039 P age Nu m b e r 1 of 2 Doc u m e n t C r e ation Dat e J une 15 2013 Im p le m e n tat ion Dat e J ul y 01 2013 W orkpla c e Violenc e B ul l y in g Ha r a ssm e nt R e sponse to C ompl a int F orm This for m i s to b e use d to docume nt an y e mpl o y e e re sponses to cla im s of vi olenc e bull y in g a ndor h a ra ssm e nt including se x ua l har a ssm e nt which oc c u rs in the wor kplac e To e nsur e tha t a ll viol e nc e bull y in g a n dor ha ra ssm e nt complaints a nd re sponses a re man a g e d a pprop ria tel y e ff e c ti ve l y a nd in a c c ord a nc e with t he C ompan y s polic y e mpl o y e e re spons e s to v iol e nc e bull y in g a ndor ha r a s sment c ompl a int s includi ng se x ua l ha ra ssm e nt compla int s will be re c ord e d usi ng thi s for m Onl y those indi vi dua ls authoriz e d to re c e i ve suc h re sponses ma y do so I f n e e de d g uidan c e c a n be o btaine d fr om Human Res ourc e s Na me of R e sponde nt Na me of C ompl a inant L oc a ti on Da te of R e sponse P lea se de sc rib e fr om y o ur po int of vie w the spe c ific incide nt of viol e nc e bull y in g a ndor ha ra ssm e nt a ll e ge d b y the Com plaina nt De sc rib e e a c h incide nt sepa ra tel y includin g t he da te tim e a nd loc a ti on Use a ddit ional pa g e s if n e c e ssa r y Did a n y on e witness the i nc ident a ll e g e d b y the Co mpl a inant Ye s No I f y e s pl e a s e prov i de the ir na me s