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Our company takes employee complaints of discrimination, harassment, and unethical or unfair conduct
as serious matters. So that we may properly investigate your concern, you are requested to fill out this
form as completely as possible. Please use additional sheets of paper where needed. After a prompt and
thorough investigation into your complaint, you will be notified of the company͛s intended action.

Employee Name: Title:

Department: Supervisors Name:
Date Complaint occurred: Time:

1.Y Please describe in as much detail as possible the nature of your complaint.

0.Y Please provide or identify all known persons, documents and witnesses to your
concerns:

G.Y Please describe how the actions you complaint about have affected your ability to
perform your job:
 u.Y Please describe any positive solutions you believe can help resolve your complaint:

Œ.Y Please provide any additional comments you wish the company to consider when
investigating your complaint:

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pomplainant͛s Signature: Date:

Supervisor͛s pomments:

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@Y Vn order to precede the complaint must be submitted in written by the
employee. The employee must set out in writing the nature of their complaint
and the reasons why they are dissatisfied with the outcome of the informal
stage. The employee should explain how they think it should be settled. This
must be submitted to the complainant͛s Director with a copy to HR.
@Y Then, the Director will appoint an investigating officer who will be asked to
provide a full written report together with any relevant documents. The
investigation should be conducted as quickly as possible while allowing for all
relevant information and evidence to be gathered. A timescale for this will be
agreed between the employee and HR.
@Y Vf the complaint be against a named individual or individuals, the HR
department will give them a copy of the complaint at the earliest opportunity.
The individual will present their response at the hearing and it would not
normally be necessary to conduct an investigation.
@Y The panel will be built consisting of a Director and another manager with a
member of HR to advice. Where possible, there will be a gender balance. The
hearing will be held within 10 working days of receipt of the investigating
officer͛s report, or within 10 working days of the complaint being received if it
is against an individual. The employee will be given five working days notice
that the hearing is to be held. The employee may request an alternative date
to allow up to an additional five working days.
@Y Any relevant written information or evidence must be made available to all
parties at the earliest opportunity and, in any case, 24 hours before the
hearing.
@Y All parties involved will be allowed to attend and make representations at the
meeting. Witnesses may be called.
@Y Refusal of either party to attend shall not invalidate the proceedings.
@Y The panel, in seeking to resolve the complaint, may adjourn the meeting or
defer a decision if more information is required.
@Y The decision of the panel, reasons for that decision and any redress will be
communicated to the employee who has made the complaint. Where the
complaint is against an individual, both parties will be given a copy of the
decision. This will be handed to the employee whenever possible or posted
directly by recorded delivery to the employee and to the employee͛s
representative, where applicable.