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Employee Grievance Form Template

Streamline Employee Feedback with Our Grievance Form Template

If employees feel unheard, issues can escalate quickly. Our Employee Grievance Form template is designed to help you create a safe channel for your team to raise concerns, fostering a more positive workplace culture. Use this template to simplify submissions, track grievances efficiently, and ensure compliance with labor regulations. It's an essential tool for any HR department looking to enhance employee satisfaction and resolve conflicts effectively. Try out the live template to see how it can support your organization's needs.

Full name
Department
Work email
Preferred contact method for follow-up
Email
Phone
In person
No follow-up requested
What type(s) of grievance are you reporting?
Please Specify:
Is the issue ongoing?
Yes
No
Date of the most recent incident
Location of the incident (site, department, or area)
How urgent is attention needed for this issue?
Not urgent
Low
Moderate
High
Critical
Confidentiality preference
Keep my identity confidential where possible
You may disclose my identity as needed
No preference
Is anyone in immediate danger?
Yes
No
List the people involved (names and roles, if known)
Witness names and contact details (if applicable)
Were there any witnesses?
Yes
No
Describe what happened (facts only, in your own words)
What impact has this had on you or your work?
Evidence or links (e.g., emails, messages, file locations)
If yes, who did you report to and when? Include any actions taken so far.
Have you reported this to anyone already?
Yes
No
Additional details about your desired resolution
What outcome would you like?
Mediation or facilitated conversation
Policy or process review
Training or coaching
Schedule or assignment change
Disciplinary review
Transfer to another team
No action; just document the concern
Not sure
Other
Please Specify:
I consent to HR/management using this information solely to investigate and resolve this grievance.
Yes
No
Type your full name as your signature
Date signed
I confirm the information provided is accurate to the best of my knowledge.
Strongly disagree
Disagree
Neither
Agree
Strongly agree
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Paper art illustration depicting an employee grievance form for FormCreatorAI article

When to use this form

Use this form when an employee needs to report a workplace issue, such as harassment, policy violations, unsafe conditions, discrimination, or repeated schedule conflicts. HR and managers benefit from clear, timestamped details that support fair, timely action. Employees get a structured way to document facts, share impact, and request a remedy. For concerns from external patrons, route them to the Customer complaint form. If a team member fears retaliation, they can submit through the Anonymous complaint form instead. This form helps you capture who was involved, what happened, and what resolution is expected, so you can triage, investigate, and close the loop with a documented outcome.

Must Ask Employee Grievance Questions

  1. What happened, including dates, times, and location?

    Specific details create a clear timeline and help verify facts with logs, schedules, or CCTV. Location also shows which team owns the response; for building disruptions, route facilities issues via the Noise complaint form.

  2. Who was involved and are you comfortable being named in the investigation?

    Listing participants and witnesses speeds interviews and reduces back-and-forth. Your preference about being named sets expectations and informs how we contact others.

  3. How has this issue affected your work, safety, or wellbeing?

    Impact helps prioritize severity, escalation, and duty-of-care needs. It also informs accommodations, such as schedule changes or interim separation.

  4. What steps, if any, have you already taken to resolve it?

    Prior actions show what has been tried and prevent duplicate outreach. They also highlight if policy channels were missed, guiding coaching and process fixes.

  5. What outcome or remedy would you consider fair?

    Knowing the desired result aligns expectations and helps evaluate proportional remedies. It frames next steps, from mediation to policy updates, and supports a clear closure note.

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