Free form template · Word

Discrimination Complaint Form

A discrimination complaint form lets an employee report that they were treated less favourably at work because of a personal characteristic, such as gender, caste, religion, disability, age, pregnancy or region. It focuses on the decision or treatment complained of and how others in a similar position were treated.

Editable Word (.docx)
Made for India
5 fill-in fields highlighted
Free, no sign-up

Download Word (.docx) — free

Preview of the form

[Highlighted] = fill in

[Company Logo][Company Name]

DISCRIMINATION COMPLAINT FORM

Company:: [Company Name]
Complaint No.:: [Reference Number]
Date:: [Date]
Classification:: Confidential

Part 1: Complainant

Employee Name
Employee ID
Designation
Department
Date of Joining
Contact Number / Email

Part 2: Ground of Discrimination

Gender
Pregnancy or maternity
Caste or community
Religion
Disability or health condition
Age
Region, language or place of origin
Marital status
Other

Part 3: Treatment Complained Of

Recruitment or confirmation
Pay, increment or bonus
Promotion or appraisal rating
Work allocation or training
Transfer or shift
Refusal of reasonable adjustment
Remarks or behaviour
Termination or other

Describe the decision or treatment
Date(s)
Decision-maker (name, designation)
Why you believe this was due to the ground selected
How others in a similar position were treated (no names needed)

Part 4: Evidence and Remedy

Documents or messages attached
Witnesses
Outcome you are seeking

Part 5: Declaration

I make this complaint in good faith. I understand that it will be reviewed confidentially by a person not involved in the decision, that I will be told the outcome, and that I will not suffer any change in my role, rating or treatment because I raised it.

Complainant
[Employee Name]
Date: [Date]

Received by
[HR Name]
Date: [Date]

Download Word (.docx) — free

What this template includes

Ground of discrimination checklist
The specific decision or treatment complained of
Who made the decision and when
Comparison with how others were treated
Evidence and witnesses
Remedy sought
Assurance of confidential, impartial review

When to use it

An employee believes they were denied promotion, increment or training because of a personal characteristic
A pregnant employee or new mother feels sidelined after returning to work
An employee with a disability is refused a reasonable adjustment
Remarks or job allocation suggest bias based on caste, religion or region

How to customise this template

1Align grounds with your equal opportunity or diversity policy
2Name a senior reviewer independent of the decision-maker
3Add a reasonable adjustment request section if relevant
4Mention the POSH IC for any sexual-harassment element
5Provide accessible formats for employees with disabilities

HR tips

Ask the decision-maker to explain criteria used, with documents
Check data: pay, ratings or promotions of comparable employees
Do not treat the complaint as a performance issue
Protect the complainant from changes to role or rating during review

This template is a starting point. Review it against applicable laws on equal remuneration, disability rights, maternity benefit and other protections, your policies, and with a legal adviser where needed.

For HR & hiring managers

Experienced and fresher candidates across India — blue, grey and white collar. Post a job in 5 minutes and start receiving applications.

Post a job free See plans

Post in 5 minutesDescribe the role in one line — we write the job description.
Verified applicantsEvery applicant has a verified mobile number.
Resume databaseSearch experienced candidates by skill, city and experience.

Frequently asked questions

What is workplace discrimination?+

Treating an employee less favourably because of a personal characteristic such as gender, caste, religion, disability, age or pregnancy, rather than on merit.

What should I include in a discrimination complaint?+

The treatment or decision, who made it and when, the reason you believe it was discriminatory, how others were treated, and any evidence.

Who reviews a discrimination complaint?+

A senior HR person or leader who was not involved in the decision complained about.

All 50 employee relations & grievances →

[Company Logo][Company Name]
EMPLOYEE COMPLAINT FORM
Company:
[Company Name]
Complaint No.:
[Reference Number]
Date:
[Date]
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)
Form · Word
Employee Complaint Form
Download .docx
[Company Logo][Company Name]
WORKPLACE COMPLAINT FORM
Site / Unit:
[Work Location]
Form No.:
[Reference Number]
Date:
[Date]
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].
About You (optional)
Name
Employee ID / Gate Pass No.
Category: Employee / Contract Worker / Trainee / Apprentice
Contractor Company (if applicable)
Department / Line
Shift
Contact Number
Type of Complaint
- Safety hazard or unsafe practice
- Washroom, drinking water or hygiene
- Canteen or food quality
- Transport or shuttle
- Wages, overtime or deductions
- Behaviour of a person
- Equipment, PPE or tools
- Other
Form · Word
Workplace Complaint Form
Download .docx
[Company Logo][Company Name]
BULLYING COMPLAINT FORM
Company:
[Company Name]
Complaint No.:
[Reference Number]
Date:
[Date]
Classification:
Confidential
Section 1: Your Details
Employee Name
Employee ID
Designation
Department
Reporting Manager
Safe contact number / email
Section 2: Person(s) Alleged to be Bullying
Name(s) and designation(s)
Relationship: Manager / Senior / Peer / Junior / Group
Section 3: Type of Behaviour
Form · Word
Bullying Complaint Form
Download .docx
[Company Logo][Company Name]
HARASSMENT COMPLAINT FORM
Company:
[Company Name]
Complaint No.:
[Reference Number]
Date of Submission:
[Date]
Classification:
Strictly Confidential
Section A: Where This Complaint Goes
- Sexual harassment: To the Presiding Officer, Internal Committee, [IC Presiding Officer Name], [IC Email]
- Other harassment (caste, religion, region, disability, appearance or other): To Human Resources, [HR Name], [HR Email]
Section B: Complainant Details
Name
Employee ID
Designation
Department
Work Location
Safe contact number / email
Section C: Respondent Details
Form · Word
Harassment Complaint Form
Download .docx
[Company Logo][Company Name]
RETALIATION COMPLAINT FORM
Company:
[Company Name]
Complaint No.:
[Reference Number]
Date:
[Date]
Classification:
Strictly Confidential – Priority
1. Your Details
Employee Name
Employee ID
Designation
Department
Safe contact number / email
2. Your Original Report or Participation
- I raised a grievance
- I made a complaint
- I made a whistleblower / ethics report
- I filed a complaint with the Internal Committee (POSH)
- I was a witness in an inquiry
- Other
Date of original report
Case / reference number (if known)
To whom it was made
Form · Word
Retaliation Complaint Form
Download .docx
[Company Logo][Company Name]
ETHICS COMPLAINT FORM
To:
Ethics Committee / Compliance Officer, [Company Name]
Reference No.:
[Reference Number]
Date:
[Date]
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.
Reporter (optional)
Name
Employee ID / Vendor Code
Department
Contact (email / phone)
I wish to remain anonymous (Yes / No)
Type of Concern
- Undisclosed conflict of interest
- Gifts, hospitality or cash against policy
- Bribery or kickbacks
- Favouritism in hiring or vendor selection
- Misuse of company assets
- Data privacy or confidentiality breach
- Falsification of records or expenses
- Other code of conduct breach
Form · Word
Ethics Complaint Form
Download .docx
[Company Logo][Company Name]
PROTECTED DISCLOSURE / WHISTLEBLOWER COMPLAINT
To:
Vigilance Officer, [Company Name] / Chairperson, Audit Committee
Reference No.:
[Reference Number]
Date:
[Date]
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
- Other serious wrongdoing
Form · Word
Whistleblower Complaint Form
Download .docx
[Company Logo][Company Name]
EMPLOYEE GRIEVANCE FORM
Company:
[Company Name]
Grievance Case No.:
[Reference Number]
Date of Submission:
[Date]
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.
Section A: Employee Details
Employee Name
Employee ID
Designation
Department
Work Location
Reporting Manager
Mobile Number
Official Email
Section B: Nature of Grievance
- Salary, wages, overtime or deductions
- Leave or attendance
- Working conditions, shift or safety
- Transfer, promotion or appraisal
- Interpersonal issue with a colleague or manager
- Application of a company policy
- Other (please specify)
Form · Word
Employee Grievance Form
Download .docx