Employee complaınt form






Employee Name:






Supervisor Name:




1.     Please describe in as much detail as possible the nature of your complaint. Please provide or identify all known persons, documents and witnesses to your concerns:




2.     Please describe how the actions you complain about have affected your ability to perform your job:



3.     Please describe any positive solutions you believe can help resolve your complaint:



4.     Please provide any additional comments you wish the company to consider when investigating your complaint:





I declare that the facts set forth in this complaint form are true and accurate pursuant to the penalty of perjury under the laws of this State/Province.




Employee signature:                                                                Date:                                      



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