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Workplace Complaint Form

Name of Complainant*

Answer required for "Name of Complainant"

Position*

Answer required for "Position"

Name of Respondent*

Answer required for "Name of Respondent"

Position*

Answer required for "Position"

Dates or time frame of incident*

Answer required for "Dates or time frame of incident"

Were actions taken to attempt resolution?*

Answer required for "Were actions taken to attempt resolution?"

Yes

If yes, dates of previous attempt at resolution

Answer required for "If yes, dates of previous attempt at resolution"

If yes, what actions were taken?

Answer required for "If yes, what actions were taken?"

Describe the incident*

State what was said/done. Use specific language if applicable. Include dates, times, locations, and names of witnesses.

Answer required for "Describe the incident"

Upload any additional information about the incident

Answer required for "Upload any additional information about the incident"

Choose a file or drag it here.