Employee Complaint Form

1
Name of Employee
2
Date of Complaint
Date
Month
Day
Year
3
Supervisor’s name
4
Describe accurately the details of your complaint and against whom:
5
Describe how the incident you are complaining about has impacted negatively on your work:
6
Describe how the company can deal effectively with your complaint:
7
Give additional comments which you believe will be important during further investigations of your complaint:
8
Supervisor’s comments:
9
By signing you declare that all information you have given here is truthful and accurate.
10
Signature
Should be Empty: