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Grievance Form · Recommended

File Employee Workplace Grievances Easily & Fairly

Empower employees to formally report workplace grievances and complaints with this structured, evidence-supported filing form for HR teams.

Use This Template Free Preview

Espresso theme

formbuilder.ai/f/employee-workplace-grievance-complaint-filing-form

Employee Workplace Grievance & Complaint Filing Form

Full Name

· · ·

Work Email Address

· · ·

Contact Phone Number

· · ·

Submit

The Employee Workplace Grievance & Complaint Filing Form provides a standardized, professional way for employees to document and submit formal complaints about workplace incidents, conduct, or policy violations. It captures essential employee details, the nature and description of the grievance, involved parties, witnesses, and any prior reporting history.

This template is ideal for HR departments, compliance officers, and organizational leaders who need a consistent and auditable process for handling employee concerns. By collecting structured information—including dates, locations, witness names, and supporting evidence uploads—it ensures every complaint is thoroughly documented and nothing is overlooked.

Using this form helps organizations demonstrate a commitment to fair and transparent grievance procedures, reduce legal liability, and foster a safer workplace culture. It can be deployed instantly, customized to match your company's policies, and submitted securely to the appropriate HR personnel for timely resolution.

3 Pages

25 Questions

~8min To complete

Free No credit card needed

Field types Short Text ×6 Long Text ×5 Single Choice ×3 Date ×2 Full Name Email Phone Dropdown daterange File Upload Priority Selection termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Employee Information 8 questions

Employee Information

1 Full Name * Full Name

2 Work Email Address * Email

3 Contact Phone Number Phone

4 Employee ID / Badge Number * Short Text

5 Department * Short Text

6 Job Title / Position * Short Text

7 Direct Supervisor / Manager Name * Short Text

8 Date of Hire Date

Page 2 Grievance Details 10 questions

Grievance & Complaint Details

1 Nature of Grievance * Dropdown

2 If 'Other,' please specify Short Text

3 Date(s) of Incident(s) * daterange

4 Location Where Incident(s) Occurred * Short Text

5 Detailed Description of Grievance — Please describe the incident(s), including what happened, who was involved, and any witnesses present * Long Text

6 Names of Individuals Involved (include titles/departments if known) * Long Text

7 Names of Any Witnesses Long Text

8 Have you previously reported this issue? * Single Choice

9 If yes, please provide details of prior report(s) — to whom, when, and what action was taken Long Text

10 Upload Supporting Evidence (emails, photos, documents, etc.) File Upload

Page 3 Resolution & Acknowledgment 7 questions

Desired Resolution & Consent

1 What resolution or outcome are you seeking? * Long Text

2 Urgency Level of This Grievance * Priority Selection

3 Would you like to remain anonymous during the investigation? * Single Choice

4 Preferred method of follow-up communication * Single Choice

By submitting this form, I affirm that the information provided is truthful and accurate to the best of my knowledge. I understand that filing a grievance in good faith is protected activity and that retaliation for filing a complaint is strictly prohibited under company policy.

5 I acknowledge that I have read and understand the company's grievance policy and that the information I have provided is true and complete. * termsandconditions

6 Employee Signature * Signature

7 Date of Submission * Date

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.