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Employee Complaint Form Template

Streamline reporting of workplace issues with ease

Struggling to manage employee grievances can lead to unresolved issues and a toxic workplace. This Employee Complaint Form Template is designed to help HR teams and managers document employee complaints clearly, ensuring that every voice is heard. Benefits include fostering a culture of transparency, improving employee satisfaction, and maintaining workplace harmony, all while ensuring compliance with legal standards. You can start using this live template to simplify your complaint management process.

Use this Template (FREE) Live Preview
Do you wish to report anonymously?
Yes
No
Full name
Department or team
Work email
Work phone
Preferred contact method
Email
Phone
Either
Please do not contact me
Type of concern
Please summarize the concern
Date of most recent incident
Where did this occur? (location, site, or context)
Timeframe of the issue
A single incident
Multiple incidents
Ongoing
Person(s) involved (names and roles, if known)
Witnesses (names and contact details, if any)
If previously reported, to whom and when?
Have you reported this previously within the company?
Yes
No
Do you have any evidence or documentation?
Yes, and I can provide it
Yes, but I prefer not to submit now
No
Not applicable
Describe any evidence (e.g., emails, messages, photos, logs)
How has this affected you or your work? (select all that apply)
Emotional distress
Physical harm or safety concerns
Work performance affected
Missed time or pay
Reputation concern
No direct impact
Other
Please Specify:
Are you concerned about retaliation?
Yes
No
How urgent is this matter?
Low
Moderate
High
Critical
Unsure
Additional details or requests
What outcome are you seeking? (select all that apply)
Formal investigation
Informal resolution or mediation
Manager awareness only
Training or coaching
Policy clarification
Record only, no action
Unsure
Other
Please Specify:
I affirm the information provided is accurate to the best of my knowledge
Strongly disagree
Disagree
Neither agree nor disagree
Agree
Strongly agree
Signature (type your name)
Signature date
I consent to be contacted about this report
Yes
No
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Paper art illustration depicting an employee complaint form template for FormCreatorAI article

When to use this form

Use this form when you need to report workplace misconduct, policy violations, discrimination, harassment, retaliation, safety concerns, or unethical behavior. Examples: a supervisor makes offensive remarks in a meeting; a coworker threatens you; payroll withholds earned overtime; a manager asks you to work off the clock; equipment is used in an unsafe way. You get a dated, documented record that HR can track and act on, while managers get the details they need to investigate and respond. This is best for formal issues that may require follow-up or discipline; for simple interpersonal feedback, you could use the Hurt feelings complaint form. The goal is a fair review, a clear next step, and protection from retaliation.

Must Ask Employee Complaint Questions

  1. What happened, when did it occur, and where?

    Specific facts, dates, and locations create a reliable timeline and help HR assess urgency. Clear details reduce back-and-forth and preserve evidence while memories are fresh.

  2. Who was involved and who witnessed it?

    Identifying parties and witnesses enables HR to corroborate accounts and contact the right people. It also helps separate direct reports from third parties to avoid conflicts of interest.

  3. Which policy, law, or expectation do you believe was violated?

    Linking the issue to a policy guides the investigation path and the level of response. If the matter needs a formal review, HR may move it into the Employee grievance form process.

  4. What impact did this have on your work, safety, or wellbeing?

    Describing impact helps prioritize risk and support needs, from schedule changes to protective measures. It also documents harm, which is essential for fair outcomes.

  5. What outcome are you seeking, and how can HR contact you for follow-up?

    Stating a desired resolution sets expectations and clarifies success. Providing contact details and availability speeds response and reduces delays.

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