Grievance Form
Employee Information
First name
*
Last name
*
Employee ID
Job Title
*
Department
Date of Submission
*
-
Year
-
Month
Day
Date
Details of the Grievance
Nature of the Grievance: (Please provide a brief description of you concern)
*
Date(s) of Incident(s): (If applicable)
People Involved: (Please list names of individuals involved, including colleagues, managers, etc)
Steps Taken So Far to Address the Issue:
Desired Outcome or Resolution: (What would you like to happen to resolve this issues?)
Supporting information (Attach any relevant documents, evidence, or communication)
Yes
No
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Additional comments:
FOR HR USE ONLY
Date:
-
Year
-
Month
Day
Date
HR Representative Assigned:
Next Steps:
Investigator Assigned:
Date of Acknowledgement to Employee
-
Year
-
Month
Day
Date
Print
Submit
Should be Empty: