Free form template · Word

Workplace Complaint Form

A workplace complaint form is a simple, open intake form that anyone working at a site, including contract workers, apprentices and trainees, can use to report a problem. It covers both people issues and workplace conditions such as facilities, hygiene, canteen, transport or safety, and routes the complaint to the right owner.

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[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

Complaint Details

Exact location (building, floor, line, bay)
Date and time noticed
Describe the problem
Person(s) involved, if any
Has this been reported before? To whom?
Urgency: High / Medium / Low
What would solve the problem?

Declaration

I confirm this complaint is made honestly. I understand it will be handled confidentially and that no one will be penalised for raising a genuine complaint.

Signature (optional)
[Name]
Date: [Date]

For Office Use

Received On	Routed To	Owner	Action Taken	Closed On
[DD/MM/YYYY]	[HR / Admin / Safety / Payroll]	[Name]	[Action]	[DD/MM/YYYY]

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What this template includes

Worker category field covering employees, contract staff and trainees
Issue type tick-boxes covering facilities, safety, conduct and pay
Exact location field such as building, floor, line or bay
Option to submit with or without name
Urgency rating so safety issues get priority
Routing section showing which department owns the complaint

When to use it

A factory, warehouse or office wants one form for all on-site complaints
Contract labour or housekeeping staff need a channel that does not depend on an HRMS login
Complaints about facilities, washrooms, drinking water, canteen or transport
A complaint box or kiosk at the site needs printed forms

How to customise this template

1List your actual site areas, lines or floors in the location field
2Add the contractor company name field for contract labour
3Print in English and the local language and place copies near the complaint box
4Assign an owner for each issue type in the routing table
5Display the POSH Internal Committee contact on the same notice board

HR tips

Open the complaint box on a fixed schedule with two people present
Treat safety complaints the same day
Publish a monthly 'you said, we did' summary without names
Never try to identify an anonymous complainant from handwriting

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Frequently asked questions

Can contract workers use the workplace complaint form?+

Yes. A workplace complaint form should be open to everyone working at the site, including contract workers, trainees and apprentices.

Can the complaint be anonymous?+

The form can allow it, though follow-up is easier when a name or contact is provided. Anonymous complaints should still be reviewed.

Who handles complaints about facilities?+

The admin or facilities team usually, with HR monitoring closure. The form's routing section records the owner.

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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[Company Logo][Company Name]
WORKPLACE CONFLICT FORM
Company:
[Company Name]
Form No.:
[Reference Number]
Date:
[Date]
1. Submitted By
Name [Employee Name]
Employee ID [Employee ID]
Designation / Department
Submitting as: Party to the conflict / Manager / Other
2. Parties Involved
Name Designation Department Working Relationship
[Employee Name] [Designation] [Department] [Peer / Reports to / Cross-team]
[Employee Name] [Designation] [Department] [Relationship]
3. Nature of Conflict
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[Company Logo][Company Name]
COMPLAINT REGARDING WORKPLACE BEHAVIOUR
Date:
[Date]
To,
[HR Name]
Human Resources
[Company Name]
[Company Address]
Subject: Complaint regarding the behaviour of [Name], [Designation]
Dear [HR Name],
I am [Employee Name], [Designation] in the [Department] team (Employee ID [Employee ID]). I am writing to formally bring to your notice the behaviour of [Name], [Designation], towards me, which I believe is not in line with the company's code of conduct.
The incidents are as follows:
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[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
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[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
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Harassment Complaint Form
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[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
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[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
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[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
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