Free agreement template · Word

Mediation Agreement

A workplace mediation agreement sets the ground rules for mediation between employees and records the terms they settle on. Signed by both parties and the mediator, it confirms that participation is voluntary and confidential, defines the mediator's neutral role and lists the agreed outcomes with a review date.

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[Company Logo][Company Name]

WORKPLACE MEDIATION AGREEMENT

Ref. No.:: [Reference Number]
Date:: [Date]
Place:: [Work Location]

This Mediation Agreement is made on [Date] at [Company Name], [Company Address], between:
Party A: [Employee Name], [Designation], [Department], Employee ID [Employee ID]
Party B: [Employee Name], [Designation], [Department], Employee ID [Employee ID]
and facilitated by the Mediator: [Mediator Name], [Designation / Organisation].

Terms

Voluntary participation: Both parties take part voluntarily and may withdraw at any time by informing the Mediator.
Role of Mediator: The Mediator is neutral, will not take sides, and will not decide who is right. The Mediator helps the parties reach their own agreement.
Confidentiality: Discussions in mediation are confidential and will not be used in any disciplinary or grievance proceeding, except where there is a risk to health or safety, or disclosure is required by law.
Notes: Any notes made by the Mediator will be destroyed after this agreement is signed, except this agreement itself.
Respect: Both parties agree to listen without interruption and to speak respectfully.
No retaliation: Neither party will be treated unfavourably for taking part in mediation, and neither will act against the other because of it.
Agreed outcomes: The parties agree to the following:
(a) [Agreed action 1]
(b) [Agreed action 2]
(c) [Agreed action 3]
Communication to others: [The parties agree that their manager will be told only that mediation was completed / other agreed wording].
Review: A review meeting will be held on [Date] with the Mediator or HR to check how the agreement is working.
Breach: If either party believes the agreement is not being followed, they may raise it with HR, who may arrange a further meeting or use other company procedures.
Other rights: This agreement does not take away any right either party has under company policy or law.

Signed copies are kept by each party and one copy by HR in a confidential file.

Party A
[Employee Name]
Date: [Date]

Party B
[Employee Name]
Date: [Date]

Mediator
[Mediator Name]
Date: [Date]

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What this template includes

Parties and mediator identified
Voluntary participation and right to withdraw
Confidentiality clause covering discussions and notes
Mediator's neutral, non-decision-making role
Agreed terms written as specific actions
Review and breach handling
Signatures of all participants

When to use it

Before a mediation session starts, to agree ground rules
At the end of mediation, to record the settlement terms
When an external mediator is engaged and roles must be clear
When a grievance is resolved through mediation instead of a formal decision

How to customise this template

1Keep clauses 1 to 6 standard and fill clause 7 with the actual settlement
2Add an exception to confidentiality for safety risks or legal obligations
3Specify who keeps the signed original
4Set the review meeting date
5Use plain language the parties understand

HR tips

Let the parties write the terms in their own words where possible
Avoid terms that require one person to admit fault
Do not include any monetary settlement for POSH complaints; those follow the Internal Committee process
Agree how the team will be told, if at all

This template is a starting point. Review it against applicable labour laws, your policies and standing orders, and with a legal adviser where needed, especially if terms affect pay or employment conditions.

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Frequently asked questions

What is a mediation agreement at work?+

A signed document that sets the rules for mediation and records the terms the parties agree, such as how they will work together.

Is a workplace mediation agreement confidential?+

Yes, discussions in mediation are normally confidential, with limited exceptions such as safety risks or legal requirements.

What if someone breaks the mediation agreement?+

The other party can raise it with HR, who may arrange a review meeting or use the grievance or disciplinary process.

All 50 employee relations & grievances →

Form · Word
Mediation Request Form
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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)
Form · Word
Employee Grievance Form
Download .docx
[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]
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
Download .docx
[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
Download .docx
[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
Download .docx
[Company Logo][Company Name]
NOTICE OF GRIEVANCE HEARING
Ref. No.:
[Reference Number]
Date:
[Date]
To,
[Employee Name]
[Designation], [Department]
Employee ID: [Employee ID]
Subject: Hearing of your grievance (Case No. [Reference Number])
Dear [Employee Name],
Further to your grievance dated [Date] concerning [brief description], you are invited to a hearing to discuss the matter in detail. The details are:
Particular Details
Date [DD/MM/YYYY]
Time [Time]
Venue / Link [Meeting Room, Address or Video Link]
Panel [Name, Designation]; [Name, Designation]
Note-taker [HR Name]
Notice · Word
Grievance Hearing Notice
Download .docx
[Company Logo][Company Name]
GRIEVANCE RESOLUTION LETTER
Ref. No.:
[Reference Number]
Date:
[Date]
To,
[Employee Name]
[Designation], [Department]
Employee ID: [Employee ID]
Subject: Outcome of your grievance dated [Date]
Dear [Employee Name],
Thank you for raising your grievance regarding [brief description] and for attending the hearing on [Date]. The matter has been reviewed by [Name, Designation], who considered your account, the documents you provided, and information gathered from [relevant departments / witnesses].
Outcome: Your grievance has been [upheld / partly upheld / not upheld].
Letter · Word
Grievance Resolution Letter
Download .docx

Mediation Agreement

Preview of the agreement

Terms

What this template includes

When to use it

How to customise this template

HR tips

Frequently asked questions

1. Person Requesting Mediation

2. Other Party / Parties

3. Summary of the Dispute

Mediation Request Form

Section A: Employee Details

Section B: Nature of Grievance

Employee Grievance Form

1. Complainant Details

2. Person(s) Complained Against

Employee Complaint Form

Subject: Acknowledgement of your grievance dated [Date]

Employee Grievance Acknowledgement

Part 1: Case Details

Part 2: Terms of Reference

Part 3: Investigator Appointment and Independence

Grievance Investigation Form

1. Executive Summary

2. Background and Terms of Reference

3. Methodology

Grievance Investigation Report

Subject: Hearing of your grievance (Case No. [Reference Number])

Grievance Hearing Notice

Subject: Outcome of your grievance dated [Date]

Grievance Resolution Letter

Name	[Employee Name]
Employee ID	[Employee ID]
Designation / Department
Role: Party to dispute / Manager / HR

Name
Designation
Department
Has the other party been informed? (Yes/No)

Employee Name
Employee ID
Designation
Department
Work Location
Reporting Manager
Mobile Number
Official Email

Name
Designation / Role
Department or Organisation (if vendor/customer)
Relationship to you (colleague, supervisor, vendor, other)

Complainant	[Employee Name], [Employee ID], [Department]
Respondent (if any): Name, Designation, Department
Date grievance received
Grievance category

Issue 1 to be investigated
Issue 2 to be investigated
Issue 3 to be investigated
Matters outside scope (if any)
Target completion date

Particular	Details
Date	[DD/MM/YYYY]
Time	[Time]
Venue / Link	[Meeting Room, Address or Video Link]
Panel	[Name, Designation]; [Name, Designation]
Note-taker	[HR Name]

Mediation Agreement

Preview of the agreement

Terms

What this template includes

When to use it

How to customise this template

HR tips

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Frequently asked questions

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