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Employee Grievance Form

An employee grievance form is the standard written route for an employee to formally raise a work-related grievance with HR or the Grievance Redressal Committee. It records what the issue is, when it began, what the employee has already tried and what outcome they are seeking, so the company can respond within its grievance policy timelines.

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[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)

Section C: Details of Grievance

Date the issue first arose
Person(s) involved (if any)
Describe what happened, in date order
How has this affected you or your work?
Steps already taken to resolve it (with whom and when)
Resolution you are seeking
Witnesses (name and designation)
Documents attached (list)

Section D: Employee Declaration

I confirm that the information given above is true to the best of my knowledge and is raised in good faith. I understand that this grievance will be handled confidentially and that the company does not permit retaliation against any employee for raising a genuine grievance. I agree to cooperate with the review process.

Employee Signature
[Employee Name]
Date: [Date]

For HR Use Only

Date received
Received by [HR Name]
Case number assigned
Assigned reviewer / committee
Acknowledgement sent on
Target date for response

[HR Name]
Human Resources
[Company Name]

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What this template includes

Employee and employment details so HR can identify the department and reporting line
Grievance category (pay, working conditions, leave, transfer, interpersonal, policy) to route the case
Chronological description with dates, so facts are clear from the start
Steps already taken, which shows whether informal resolution was attempted
Desired resolution, which helps HR propose a practical outcome
Supporting documents and witnesses list
Confidentiality and non-retaliation assurance to encourage honest reporting
HR-use section for case number, receipt date and assigned officer

When to use it

An employee is unhappy about salary, overtime, leave, transfer, shift allocation or appraisal decisions and wants a formal review
An informal conversation with the reporting manager has not resolved the issue
Your grievance policy or standing orders require grievances to be submitted in writing
A Grievance Redressal Committee needs a consistent intake document for every case

How to customise this template

1Replace [Company Name] and add your logo and grievance policy reference number in the header
2Edit the grievance categories to match those in your grievance policy or certified standing orders
3Insert the name and email of your Grievance Redressal Officer or committee
4State your internal response timeline in the HR-use section as per your own policy
5Add a regional-language version for shop-floor staff if needed

HR tips

Always issue a written acknowledgement with a case number once the form is received
Sexual-harassment complaints should not go through this form; redirect them to the POSH Internal Committee
Restrict access to the form to HR and the assigned reviewer only
Do not reject a grievance because it is handwritten or in a regional language

This template is a starting point. Review it against applicable labour laws, the Labour Codes and state rules, your standing orders and grievance policy, and with a legal adviser where needed.

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Frequently asked questions

What is an employee grievance form?+

It is a written form an employee uses to formally raise a work-related complaint or dissatisfaction with HR. It creates a record so the company can investigate and respond fairly.

Who should an employee submit the grievance form to?+

Usually to HR or the Grievance Redressal Officer named in the company policy. If the grievance is about the reporting manager, it should go directly to HR or the next-level manager.

Can a sexual harassment complaint be filed on a grievance form?+

It is better to file it with the Internal Committee under the POSH Act 2013, which has its own procedure. HR should guide the employee to the IC if such a complaint arrives on a grievance form.

Is the grievance form kept confidential?+

Yes. Only people directly involved in reviewing the grievance should see it, and the employee should be protected from any retaliation for raising it in good faith.

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)
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Employee Complaint Form
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[Company Logo][Company Name]
ACKNOWLEDGEMENT OF GRIEVANCE
Ref. No.:
[Reference Number]
Date:
[Date]
To,
[Employee Name]
[Designation], [Department]
Employee ID: [Employee ID]
[Work Location]
Subject: Acknowledgement of your grievance dated [Date]
Dear [Employee Name],
We acknowledge receipt of your grievance submitted on [Date] regarding [brief neutral description of grievance]. It has been registered under case number [Reference Number]. Please quote this number in all future communication on this matter.
Your grievance has been assigned to [Reviewer Name], [Reviewer Designation], who will review the matter in line with the company's Grievance Redressal Policy. The next steps are:
Letter · Word
Employee Grievance Acknowledgement
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[Company Logo][Company Name]
GRIEVANCE INVESTIGATION FORM
Case No.:
[Reference Number]
Date Opened:
[Date]
Classification:
Strictly Confidential
Part 1: Case Details
Complainant [Employee Name], [Employee ID], [Department]
Respondent (if any): Name, Designation, Department
Date grievance received
Grievance category
Part 2: Terms of Reference
Issue 1 to be investigated
Issue 2 to be investigated
Issue 3 to be investigated
Matters outside scope (if any)
Target completion date
Part 3: Investigator Appointment and Independence
Form · Word
Grievance Investigation Form
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[Company Logo][Company Name]
EMPLOYEE COUNSELLING FORM
Ref. No.:
[Reference Number]
Date of Session:
[Date]
Record Type:
Non-disciplinary
Employee Details
Employee Name
Employee ID
Designation
Department
Reporting Manager
Counselled by (name and designation)
Area of Concern
- Work quality or targets
- Attendance or punctuality
- Workplace behaviour
- Adherence to process or policy
- Other
Discussion
Form · Word
Employee Counselling Form
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[Company Logo][Company Name]
EMPLOYEE CONCERN FORM
Company:
[Company Name]
Form No.:
[Reference Number]
Date:
[Date]
Use this form to share an early concern, question or suggestion. It is informal and confidential. For safety emergencies, contact your supervisor immediately. For sexual harassment, please contact the Internal Committee at [IC Email].
Your Details (optional)
Employee Name
Employee ID
Department
Preferred contact (email / phone)
What is your concern about?
- Workload or working hours
- Wellbeing or stress
- Team or manager communication
- Clarity on a company policy
- Change in the organisation (shift, location, structure)
- Tools, systems or resources
- Suggestion for improvement
- Other
Form · Word
Employee Concern Form
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[Company Logo][Company Name]
EMPLOYEE RELATIONS CASE FORM
Case No.:
[Reference Number]
Date Opened:
[Date]
Opened by:
[HR Name]
Classification:
Confidential
A. Case Source
- Employee (written)
- Employee (verbal)
- Manager referral
- Ethics / whistleblower channel
- Exit interview
- Other
B. Case Type
- Grievance
- Conduct complaint
- Bullying / behaviour
- Discrimination
- Retaliation
- Attendance / performance
- Workplace conflict
- Sexual harassment (refer to Internal Committee)
- Other
C. Parties
Form · Word
Employee Relations Case Form
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[Company Logo][Company Name]
EMPLOYEE STATEMENT
Case No.:
[Reference Number]
Date:
[Date]
Classification:
Confidential
1. Employee Details
Employee Name
Employee ID
Designation
Department
Reporting Manager
Role: Person raising the matter / Person the matter concerns / Involved in incident
2. Matter Being Addressed
Incident or matter (as communicated by HR)
Date of incident
Date the matter was communicated to you
3. Your Response
Form · Word
Employee Statement Form
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[Company Logo][Company Name]
GRIEVANCE INVESTIGATION REPORT
Case No.:
[Reference Number]
Report Date:
[Date]
Prepared by:
[Investigator Name], [Designation]
Submitted to:
[Decision Maker Name]
Classification:
Strictly Confidential
1. Executive Summary
This report sets out the investigation into the grievance raised by [Employee Name], [Designation], on [Date]. Of the [Number] issues investigated, [Number] were substantiated, [Number] were not substantiated and [Number] were inconclusive.
2. Background and Terms of Reference
[Brief neutral description of the grievance.] The investigator was appointed on [Date] by [Name] to examine: (a) [Issue 1]; (b) [Issue 2]; (c) [Issue 3].
3. Methodology
Report · Word
Grievance Investigation Report
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