Employee Complaint Form


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									This Employee Complaint Form is a form to be filled out by an employee describing a
complaint related to his or her employment. The form sets forth the details of the
complaint or incident and is presented to the employer to review. Upon receipt, the
employer reviews the complaint and determines the appropriate course of action to
follow. It is important for employers to properly document employee complaints in order
eliminate inappropriate conduct and to provide its employees with a productive working
environment. Employers should make this complaint form available to their employees
when they have an employment-related complaint.
                              EMPLOYEE COMPLAINT FORM

We at ___________ [Instruction: Insert Company Name] (“Company”) take employee
complaints of harassment, discrimination unethical or unfair conduct or treatment very seriously.
In order for Company to properly investigate your issue, please answer the below questions as
thoroughly as possible. Company will investigate the complaint and in no less than five (5)
business days, Company will notify you of Company’s intended action.

   1. Employee Name:

   2. Title:

   3. Department:

    4. Please describe, in as much detail as possible, the nature of your complaint, providing, in
as much detail as possible, information regarding the persons involved, the dates, who might
have witnessed, any applicable documents and other corroborative evidence:

   5. How has the issue described above negatively impacted your ability to perform your job:

   6. Suggest how you would like Company to remedy the issue:

    7. Please provide any other information related to the above-described issue that you would
like the Company to be aware of:

The foregoing represents a complete and accurate description of the above-described event.

Employee Signature: _________________________

Date:                                                                               ___________

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