Employee Complaint Intake Form - Free Editor
EMPLOYEE COMPLAINT INTAKE FORM
Complainant Name: [NAME]
Employee ID: [ID]
Department: [DEPARTMENT]
Supervisor: [SUPERVISOR]
Date of Complaint: [DATE]
1. Nature of Complaint
☐ Harassment
☐ Discrimination
☐ Retaliation
☐ Safety concern
☐ Wage or hour concern
☐ Policy violation
☐ Other: [OTHER]
2. Description of Complaint
[DESCRIBE EVENTS, DATES, LOCATIONS, AND PEOPLE INVOLVED]
3. Witnesses
[LIST NAMES AND CONTACT INFORMATION]
4. Supporting Documents
[LIST OR ATTACH]
5. Desired Resolution
[DESCRIBE WHAT YOU ARE SEEKING]
6. Acknowledgment
The Company will review this complaint promptly. The Company will maintain confidentiality to the extent possible and will not tolerate retaliation.
Complainant Signature: ___________________________
Date: [DATE]
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