Employee Complaint Form

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1. Employee name:

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2. Employee phone number (optional):

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3. Employee email:

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4. Manager name:

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5. Manager phone number:

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6. Manager email:

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7. Department:

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8. Date of complaint:

Date

Date

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9. Employee statement:

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10. Please provide the name and department of the employee(s) involved in the complaint, and their role:

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11. Additional comments: