An employee complaint form is used when there is a complaint by an employee against another employee, senior manager or supervisor. It is a way of documenting any complaint especially in case of a lawsuit. This form can be used as evidence and it is important for the information to be accurate.
Company name: __________________________________________________________
Name of employee: _______________________________________________________
Date of complaint: ________________________________________________________
Supervisor’s name: ________________________________________________________
Describe accurately the details of your complaint and against whom: ________________
________________________________________________________________________
________________________________________________________________________
Describe how the incident you are complaining about has impacted negatively on your work: __________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Describe how the company can deal effectively with your complaint: ________________
________________________________________________________________________
________________________________________________________________________
Give additional comments which you believe will be important during further investigations of your complaint: _____________________________________________
________________________________________________________________________
________________________________________________________________________
Supervisor’s comments: ____________________________________________________
________________________________________________________________________
________________________________________________________________________
Complainant’s Signature: ______________________ Date: ___________________
By signing you declare that all information you have given here is truthful and accurate
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