Harassment log and report letter
A printable from Sexual Harassment at Work. Fill it in by hand. Nothing you write is collected by this website.
Harassment log and report letter
My log (keep at home or on your own phone)
| Date and time | What was said or done (exact words) | Who | Who saw or heard | Who I told |
|---|---|---|---|---|
- I saved screenshots of texts or messages, with dates
- I told someone I trust: __________ on __________
- I wrote down changes to my hours or shifts after I spoke up
Sample report to my employer (keep a copy and the date you sent it)
Date: __________ To: (manager or human resources)
I am reporting sexual harassment at work. On (dates), (name) (describe what happened in a few words). This was unwelcome. I am asking the company to make it stop and to keep me safe at work. Please tell me in writing what you will do.
Name: __________
Before I quit
- I talked with a clinic, or called (415) 404-9093
- I saved my own proof
- I know my final pay rules (72 hours' notice: paid on my last day; no notice: within 72 hours)
- I know my state deadline (generally 3 years from the last incident)
Do not write your immigration status on this sheet.
From Sexual Harassment at Work. Facts checked October 21, 2026. Free information, not legal or medical advice.