Employee complaınt form

Type: 

 

 

EMPLOYEE COMPLAINT FORM

 

Employee Name:

 

Title:

 

Department:

 

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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