A bullying complaint form helps an employee report a pattern of repeated, intimidating or undermining behaviour at work, by a peer, group or manager. It is built around an incident log, because bullying is usually about repetition, and captures power dynamics, online bullying and the support the employee needs immediately.
Relationship: Manager / Senior / Peer / Junior / Group
Section 3: Type of Behaviour
Shouting, insulting or name-calling
Public humiliation or belittling
Deliberate exclusion from meetings or information
Unreasonable workload or impossible deadlines
Threats about job, appraisal or transfer
Spreading rumours
Offensive messages on email or chat groups
Other
Section 4: Incident Log
Date
What Happened
Where / Channel
Witnesses
Evidence
[DD/MM/YYYY]
[Description]
[Office / WhatsApp / Email]
[Names]
[Screenshot / none]
[DD/MM/YYYY]
[Description]
[Channel]
[Names]
[Evidence]
[DD/MM/YYYY]
[Description]
[Channel]
[Names]
[Evidence]
[DD/MM/YYYY]
[Description]
[Channel]
[Names]
[Evidence]
Section 5: Impact and Support
How has this affected your health, work or attendance?
Have you raised it before? With whom?
Immediate support needed (change of seating, reporting line, counselling)
Outcome you are seeking
Section 6: Declaration
I make this complaint in good faith and the information is true to my knowledge. I understand it will be reviewed impartially by someone outside the reporting line of the persons involved, kept confidential, and that I will not be victimised for making it.
This form is used to report conduct that you believe breaches company rules or the code of conduct. All complaints are treated confidentially. If your complaint relates to sexual harassment, please approach the Internal Committee directly as per the company's POSH policy.
1. Complainant Details
Employee Name
Employee ID
Designation
Department
Work Location
Contact Number
Preferred mode of contact
2. Person(s) Complained Against
Name
Designation / Role
Department or Organisation (if vendor/customer)
Relationship to you (colleague, supervisor, vendor, other)
Anyone working at this site may use this form. You may give your name or leave it blank. For complaints of sexual harassment please contact the Internal Committee: [IC Presiding Officer Name], [Phone].
Use this form to report a suspected breach of the Code of Conduct. You may remain anonymous. Submit to [Ethics Email] or the sealed ethics box at [Location]. Sexual harassment complaints should be made to the Internal Committee.
This disclosure is made under the company's Whistleblower / Vigil Mechanism Policy. Mark the envelope 'Protected Disclosure – Confidential' or email [Vigilance Email]. Your identity will be protected.
1. Whistleblower Details (kept separately and confidential)
Name
Employee ID
Designation / Department
Safe contact
I wish to remain anonymous (Yes / No)
2. Nature of Wrongdoing
Financial fraud or misappropriation
Manipulation of accounts or records
Violation of law or regulation
Falsification of safety, quality or test data
Abuse of authority
Leak of confidential or price-sensitive information
Use this form to formally raise a work-related grievance. Please write clearly and attach any supporting documents. Complaints of sexual harassment must be submitted to the Internal Committee under the company's POSH policy and not on this form.