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Employee Complaint Form Template

An employee complaint form is a very important document as it can be used in a court of law as evidence when facing a lawsuit.  It enables thecomplaint to be recorded accurately and truthfully.  This template can be used as an example about the general format of such forms.

Name of the company: _____________________________________________________

Name of employee: _______________________________________________________

Job title: ______________________________________________________

Date of complaint: ________________________________________________________

Describe in detail the nature of your complaint including names of all individuals involved, witnesses of the incident and any proof you might have about the complaint: __

________________________________________________________________________

________________________________________________________________________

Give details about how the incident has affected your ability to work effectively: ______

________________________________________________________________________

________________________________________________________________________

What actions could the company take in order to effectively deal with your complaint? __

________________________________________________________________________

________________________________________________________________________

Give any additional comments that would be helpful in dealing with your complaint: ___

________________________________________________________________________

________________________________________________________________________

Employee signature: _________________________ Date: _______________

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