GRIEVANCE FORM SLIP HR
Employee Information
Full Name: [Employee's Full Name] | Position: [Employee's Position] |
Employee ID: [Employee ID] | Date of Submission: [Date] |
Department: [Employee's Department] | Received by: [Receiver’s Name] |
Grievance Details
Nature of Grievance: (Check the applicable box) |
Harassment Discrimination Retaliation Workload Compensation Benefits Work Conditions Conflict with Colleague Other (Please Specify): ________________ |
Description of Grievance |
[Include a detailed description of the grievance, including the names of individuals involved, dates, times, locations, and any supporting evidence or documents.] [Description]: ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ |
Resolution Sought |
[Describe the specific resolution or action you are seeking to address this grievance.] [Resolution Sought]: ________________________________________________________________________________________________________________________________________________________________________________________________ |
Witness Information
Full Name: [Witness's Full Name] | Department: [Witness’s Department] |
Employee ID: [Witness's Employee ID] | Date of Submission: [Date] |
Attachments (if any)
Acknowledgment
I hereby acknowledge that the information provided in this Grievance Form Slip is true and accurate to the best of my knowledge. I understand that this grievance will be handled confidentially and in accordance with company policies and procedures.
Employee's Signature: [Signature]
Date: [Date Signed]
For HR Use Only
Date Received: [Date] | Received by: [HR Representative Name] |
Action Taken: Investigation Initiated Referred to Appropriate Department Other: ___________________ |
HR Representative's Comments:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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