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1. Document Title and Date: Clear identification of the document as a Harassment Acknowledgement Form, including date of issuance and document version number
2. Employee Information: Fields for employee name, ID number, department, and position
3. Purpose Statement: Clear statement of the document's purpose and the company's commitment to maintaining a harassment-free workplace
4. Definitions: Comprehensive definitions of different forms of harassment (moral, sexual, discriminatory) as per Belgian law
5. Prohibited Behaviors: Detailed list of behaviors that constitute harassment under company policy and Belgian law
6. Reporting Procedures: Step-by-step process for reporting harassment, including contact information for relevant personnel and prevention advisors
7. Non-Retaliation Statement: Clear statement that retaliation against anyone who reports harassment is prohibited
8. Consequences: Overview of potential disciplinary actions for policy violations
9. Acknowledgment Statement: Employee's confirmation of reading, understanding, and agreeing to comply with the policy
10. Signature Block: Space for employee signature, date, and witness signature if required
1. Language Selection: Required when the form needs to be available in multiple Belgian official languages (French/Dutch/German)
2. External Resources: List of external support services and resources for harassment victims, recommended for larger organizations
3. Industry-Specific Examples: Examples of harassment specific to the industry context, recommended for high-risk sectors
4. Remote Work Considerations: Additional provisions for harassment in remote work settings, necessary for companies with remote workers
5. Digital Harassment Policy: Specific section addressing online and digital forms of harassment, recommended for technology-oriented workplaces
1. Appendix A - Contact Information: Complete list of relevant contact persons including prevention advisors, HR representatives, and confidential counselors
2. Appendix B - Reporting Form Template: Standard template for formal harassment complaints
3. Appendix C - Legal References: Relevant excerpts from Belgian legislation and EU directives regarding harassment
4. Appendix D - Company-Specific Procedures: Detailed internal procedures and flowcharts for handling harassment complaints
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