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Employee complaint and grievance form template

Here is a template for an employee complaint and grievance form:


Employee Information

Full name:

Department:

Job title:

Date of complaint:

Nature of Complaint

Please provide a brief description of your complaint:


Details of Complaint

Please provide a detailed description of the complaint, including:


Who was involved?

When did the incident(s) occur?

Where did the incident(s) occur?

What specifically happened?

How did it impact you?

Previous Actions Taken

Have you taken any actions to resolve the complaint? If so, please describe:


Desired Outcome

What outcome would you like to see as a result of your complaint?


Witnesses

Were there any witnesses to the incident(s)? If so, please provide their names and contact information:


Signature

By signing below, you acknowledge that the information provided in this form is true and accurate to the best of your knowledge:


Employee signature: __________________________


Date: ________________


Acknowledgment of Receipt

I acknowledge receipt of this complaint and will take appropriate action to investigate and resolve the matter.


Manager signature: __________________________


Date: ________________

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