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. CLP management will contact you.
Full Name
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Name of Jobsite/Company
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Date of incident
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Month
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Day
Year
Date Picker Icon
Supervisor’s name
*
Describe accurately the details of your complaint and against whom:
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Describe how the incident you are complaining about has impacted negatively on your work:
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Describe how the company can deal effectively with your complaint:
Did do you report the incident? To whom? Date?
Give additional comments which you believe will be important during further investigations of your complaint:
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.
Signature
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Clear
Date
*
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Month
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Day
Year
Date
Submit Complaint
Should be Empty: