Internal Grievance & Complaint Form

# Internal Grievance & Complaint Form This form is used to submit a formal internal grievance or workplace complaint. Completing and signing this form initiates the company's formal grievance process. All complaints are taken seriously and will be reviewed by HR. Retaliation against any employee for submitting a complaint in good faith is prohibited and is itself a policy violation. You may also contact an attorney or a government agency (such as the EEOC or relevant state labor board) at any time. --- ## Section 1 — Complaining Employee Information **Company Name:** ___________ **Your Full Name:** ___________ **Employee ID / Personnel Number:** ___________ **Your Job Title:** ___________ **Your Department:** ___________ **Your Direct Manager Name:** ___________ **Your Work Email:** ___________ **Your Work Phone / Extension:** ___________ **Your Preferred Contact Method:** ___________ **If you prefer to be contacted at a personal email, provide it here (optional):** ___________ **Date This Form Is Submitted:** ___________ --- ## Section 2 — Confidentiality & Anonymity Complaints submitted through this form are handled with discretion. However, fully anonymous complaints may limit the company's ability to investigate and resolve the matter. **Do you consent to HR sharing your identity with the respondent(s) named in this complaint if required for investigation?**