Employee Concern/Complaint Form

Employee Concern/Complaint Form

If you have a complaint or concern, or experience a problem that affects you or your co-workers. We ask that you complete this form immediately after the incident or problem first occurred. IWF management will contact you.
Full Name / Nombre completo*
Name of Jobsite/Company / Nombre del lugar de trabajo/empresa*
Date of incident / Fecha del incidente*

MonthDayYear
Supervisor’s name/Nombre del supervisor*
Witnesses Names/Nombre de Testigos
Your Phone Number/Su Numero de Telefono*
Email/Correo Electronico*
Describe accurately the details of your complaint and against whom/Describa con precisión los detalles de su queja y contra quién::*
Describe how the incident you are complaining about has impacted negatively on your work/Describa cómo el incidente del que se queja ha impactado negativamente en su trabajo:*
Describe how the company can deal effectively with your complaint. What solution or outcome do you wish to occur?/Describa cómo la empresa puede tratar eficazmente su queja. Que solucion espera?:
Did do you report the incident when it happened? To whom? Date? If not, why not?/ ¿Reportaste el incidente ciando paso? ¿A quien? ¿Fecha? si no lo reporto cual es la razon?
Give additional comments which you believe will be important during further investigations of your complaint/Proporcione comentarios adicionales que crea que serán importantes durante futuras investigaciones de su queja::
By my signature below, I confirm that I am submitting this report in good faith and the information provided above accurately reflects my recollection of the incidents related to my complaint.

Con mi firma a continuación, confirmo que envío este informe de buena fe y que la información proporcionada anteriormente refleja con precisión mi recuerdo de los incidentes relacionados con mi queja.
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: