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Good afternoon, welcome to just answer. I am a solicitor and reviewing your question now for you.
There is no standard format for a grievance letter. You will just need to put your complaint in writing and addressed to the department that is stated in the grievance procedure as responsible for dealing with grievances. You want to be clear that you believe you are a victim of harassment and say what has actually happened that makes you believe you have been a victim and the implications to your well being and confidence and how it is affecting your work as the environment is not conducive. Advise what you would like as outcome. The grievance procedure will say how long you will need to wait before they respond. Any clarification please do not hesitate to send your follow up question. All the best.