EMPLOYEE COMPLAINT FORM
Employee Name: |
Title: |
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Department: |
Supervisor Name: |
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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: