Delegal Law Offices

Sexual Harassment Questionnaire

Are you a U.S. Citizen?

Employer about whom you are contacting us:

Address of employer:

Did your employer employ:

Rate of Pay


Hire Date:

Date(s) of the sexual harassment:

Are you still employed at the place where the harassment took place?

Were you issued any employment evaluations?

Did you receive any other awards or other evaluations of your employment?

Were you ever disciplined in the past prior to the event about which you are currently complaining?

Are there any written documents outlining the terms of your employment?

Was your position covered by Union contract (even if you are not a union member)?

Who is the person that harassed you?

What is the gender of that person?

Was that person a supervisory employee?

Was that person your supervisor?

What position did that person hold in the company?

Did the harasser ever offer any benefit?

Did the harasser ever threathen any adverse action if you did not submit to advance or improper conduct?

Did the harasser ever touch you inappropriately on any part of your body?

Did you ever communicate to the harasser that you did not want to continue any relationship with the harasser?

Did you ever engage in sexual relations with the harasser?

Did the harasser ever take any other action which you believed to be harassing?

Did you ever notify your harasser that you wished that he or she would stop the harassment?

Did your employer have a sexual harassment policy?

Did you report the harassment?

Was the incident ever investigated?

How has the harassment affected you personally?

Do you believe that any disciplinary action was taken against you based on your complaint to any agency, your report of illegal activity, your refusal to participate in illegal activity, or your objection to illegal activity?

Were you paid overtime payment of time and a half your regular wage for hours worked in excess of 40 a week?

What person or company did you charge with violating employment laws or regulations?

What employment laws or regulations did you contend that the company violated?

Have you ever previously formally charged any employer with violation of employment law (for example, violations of overtime laws, OSHA regulations, or EEOC violations)?

Have you ever sued anyone before for any reason?

How did you learn of our firm?

Additional Information

Please provide any additional information about yourself or the case which would help the attorneys understand you potential case or explain your answers to the above questions.


We will contact you by phone or email unless you request some alternate means of communication.


I have prepared the answers to these questions to the best of my ability.

I understand that the submission of this form does not create any obligation for me or for any attorney at Delegal Law Offices.

I further understand that submission of this form does not create an attorney-client relationship and that the lawyer is not obligated to schedule a meeting with me.

I understand and agree that Delegal Law Offices, P.A., will have no duty to keep confidential the information that I am transmitting to the law firm through this questionnaire.


I agree with the terms of this form

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Recent Awards: Tad Delegal Presented the 2017 Non-Compete Seminar portion of the Florida Bar's Certification Review Course

2016 Florida Trend Legal Elite
2015 904 Magazine’s Legal Elite
2015 U.S. News & World Report Law Firm of the Year