Employee Complaint Form

1
Company Name
2
Name of Employee
3
Date of Complaint
Date
Month
Day
Year
4
Supervisor’s name
5
Describe accurately the details of your complaint and against whom:
6
Describe how the incident you are complaining about has impacted negatively on your work:
7
Describe how the company can deal effectively with your complaint:
8
Give additional comments which you believe will be important during further investigations of your complaint:
9
Supervisor’s comments:
10
By signing you declare that all information you have given here is truthful and accurate.
11
Signature
Should be Empty: