Employee Complaint Form Template

Dear Employee,

We value your feedback and want to address any concerns you may have. Please use the
following form to submit your complaint. Your input is essential for creating a positive work
environment.

Employee Information
Name: [Employee's Full Name]
Employee ID: [Employee ID]
Department/Team: [Department/Team Name]
Position/Job Title: [Employee's Position]
Complaint Details
Date of Incident: [DD/MM/YYYY]
Time of Incident: [HH:MM AM/PM]
Location of Incident: [Where the incident occurred]
Nature of Complaint: [Brief description of the complaint]
Witnesses (if any)
Witness 1 Name: [Full Name]
Witness 1 Contact: [Phone Number/Email]
Witness 2 Name: [Full Name]
Witness 2 Contact: [Phone Number/Email]
Detailed Description
Provide a detailed account of the incident or issue: [Use additional space as needed]
Resolution Requested
Desired Resolution: [What outcome are you seeking?]
Additional Information
Documents/Proof (if any): [Attach any relevant documents]
Have you reported this complaint elsewhere? [Yes/No]
If yes, provide details: [Where and when]
Confidentiality
Do you wish to keep this complaint confidential? [Yes/No]
Disclaimer: The information provided will be treated confidentially and used solely for
addressing the complaint.

Submit by: [Employee's Signature] / [Date]