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: ________________
Comments