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Employee Complaint Form
It is company policy to investigate all complaints and take appropriate action. If you wish, please
use this form to document your complaint, and submit it to the Office Manager / Human
Resources Representative.
The person(s) involved in this complaint are:
Note all relevant dates, places, events, etc. pertaining to the complaint: (Use second sheet if
necessary.)
It may become necessary to disclose your identity and/or complaint, as well as to conduct a
formal investigation. Should such a disclosure become necessary, it will be only to the person(s)
with a need to know your identity or the details and nature of the complaint.
I acknowledge that I have read this document and understand my obligation to provide
information as needed and to cooperate fully and completely with any investigation of this
complaint. Should it become necessary, I authorize the company to disclose my identity and/or
details of this complaint.
Your Name: ____________________________________________________________
Signature: _____________________________________ Date ___________________
Office Manager / HR Representative: ________________________________________
Signature: _____________________________________ Date ___________________
The HR-related content of this form was originally produced by The HR Support Center, a strategic resource partner of MidwestHR
Legal Disclaimer: The Employee Complaint Form is intended for informational purposes only, and does not constitute legal
information or advice. This information and all HR Support Center materials are provided in consultation with federal and state
statutes, and do not encompass other regulations that may exist, such as local ordinances. Transmission of documents or
information through the HR Support Center does not create an attorney-client relationship. If you are seeking legal advice, you are
encouraged to consult an attorney.