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Exhibit M

SAMPLE EMPLOYEE HARASSMENT AND OTHER INAPPROPRIATE CONDUCT INVESTIGATION FORM

Name of Person Allegedly Harassed

__________________________________

Position/Location:

__________________________________

Employee Registering Complaint

__________________________________

Complaint Received by:

__________________________________

Date/Time:

________________________

__________

1.

How was the complaint brought to your attention? (Check one)

3.

Nature of Complaint: Please document below complaint exactly as reported. Include names, dates, relationships, incidents, etc. Use additional paper as needed.

__ __ __ __

___________________________________ ___________________________________ ___________________________________ ___________________________________

______________________________________ ______________________________________ ______________________________________ __________________________

4.

List below specifics as to the nature of alleged harassment (use additional paper as needed)

2.

_____

In Person

_____

In Writing

_____ _____

Reported Cause of Complaint/Harassment:

National Origin Religion Other (Please describe

__________)

_____

Race

_____

Sex

_____

Age

By Telephone Other (Please describe

__________)

_____ _____

_____

Physical Contact:_________________________________________________________ _______________________________________________________________________ Words:_________________________________________________________________ _______________________________________________________________________ Threat:_________________________________________________________________ _______________________________________________________________________ Offer or Promise:_________________________________________________________ _______________________________________________________________________

G e s t u r e s : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

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