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Grievance Report
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Please enable JavaScript in your browser to complete this form.
Name – Leave Blank For Anonymous Report
Location and Team Name
*
Email – Leave Blank For Anonymous Report
Today's Date
*
Grievance Details
Please provide information about the event leading to the grievance.
Leave other list
Date of Incident
*
Location of Incident
*
Ex: Marks Tavern and Restaurant
Time of Incident
*
What Was Your Involvement?
*
Directly Involved
Witness
Who was directly involved?
*
Please list names and titles of those who were directly involved in the incident. Please exclude witnesses from this list.
Who witnessed the incident?
*
Please list the names and titles of those who witnessed the incident.
Describe the incident.
*
Please provide as much detail as possible, including relevant events that led up to the incident.
If any policies, procedures, or other guidelines were violated during the incident, please list them below.
Cite specific information from the employee handbook when possible.
Please list any additional comments or information.
Terms and Agreement
*
I understand and agree to the terms listed here.
I submit this form and confirm that everything on it is true and complete to the best of my knowledge. I understand that providing false information can lead to disciplinary action and/or termination.
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