Steven Granberg, Attorney at Law, P.A.

Steven Granberg, Attorney at Law, P.A.

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Tell Us About Your Case > Employment Harassment Questionnaire

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Employment Harassment Questionnaire

To prove harassment, the nature (what was done), severity, duration (how long did it go on), and location (at work or elsewhere) are all crucial elements. The following questions try to get specific information on these and a few other criteria. Check the boxes which apply and try to provide as much detail as possible.

Please note there is no limit to the amount of information you can enter. The boxes will scroll as necessary as you add additional information.


  1. Where is the employer located and how many employees does the employer have?


  2. Does the employer have a written anti-harassment policy?
    Yes No

    If yes, do you have a copy of this policy?
    Yes No

  3. Basis of harassment?
    Age Disability Race/National Origin Gender Other


    If other, please describe.


  4. Please provide the names and job titles of the person(s) who harassed you.


  5. What was the harassment?
    Spoken (slurs, derogatory terms, inappropriate language)
    Physical (inappropriate touching, gestures)
    Other form of harassment (gestures, gazes, etc)


    If the harassment was spoken, what was said?


    If the harassment was physical, where and how were you touched?


    If the harassment was of another kind, please describe it.


  6. When did the harassment occur, and how often?


  7. Were there any witnesses to the harassment?
    Yes No

    If yes, please provide their name, addresses, telephone numbers and any other contact information.


  8. Have you complained or mentioned the harassment to others?
    Yes No

    If yes, to whom have you complained or mentioned the harassment?
    supervisor upper management
    personnel/human resources co-workers others


  9. Were your complaints spoken or written?
    spoken written written and have copy


  10. When and to whom (names and job titles) did you complain?


  11. What was the response of the person to whom you complained?


  12. What sort of action was taken against the harasser?
    no action taken reprimand suspension
    termination other


  13. If the person who harassed you has harassed others, please provide details of the harassment (including who was harassed, when and where, and the nature of the harassment).


  14. Was the employer aware of this earlier, other harassment?
    Yes No

    If yes, how was the employer made aware of this other harassment?


  15. What action did the employer take to discipline the other harassment?
    Took no action Reprimand Termination
    Suspension Other


  16. Has anyone else at this employer previously harassed employees?
    Yes No

    Please provide details of the harassment (including who was harassed, when and where, and the nature of the harassment).


  17. What action has the employer taken against other harassment?
    Took no action Reprimand Termination
    Suspension Other


  18. Has the EEOC or the New Mexico Human Rights Division (HRD) investigated similar complaints against the harasser or employer?
    Yes No I Don't Know

    If yes, who filed the complaints, when was the complaint filed, and what were the allegations?


  19. Have lawsuits been filed against the harasser or employer?
    Yes No I Don't Know

    If yes, please describe the nature of the lawsuit, including when it was filed, what court it was filed in, and whether it was filed against the employer or against the harasser.


  20. Have you previously complained about harassment at either a prior job, or about a different person at your current job? Yes No

    If yes, please describe when the complaint was filed, against whom, and what happened after you had complained.


  21. How have you been damaged by the harassment?
    Lost Earnings Physical Injuries
    Non-Physical (for example, emotional distress) Other


  22. What are your goals? What do you want to accomplish?


  23. Please describe your damages.


  24. Please add any other information you feel is important.



WARNING: The privileged information transmitted via the form below is not secure or encrypted. If you feel uncomfortable providing any of the information below, please leave it blank. If you prefer, you may also provide this information via fax, telephone or by visiting our office. Submitting a questionnaire does not create an agreement by you or our office to provide legal representation on any matter.

 
 

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DISCLAIMER: All information on this website is general in nature and does not constitute legal advice. We take no responsibility for errors. Submitting a questionnaire does not create an agreement by you or our office to provide legal representation on any matter.
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Albuquerque, New Mexico 87109-4401
Phone: 505-244-3779
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