Grievance form and register

Part A: grievance form

Name: ____________ Employee ID: ____________ Department: ____________ Date: ____________

You may raise a concern in your own name or with the help of a colleague. If you would like to stay anonymous, tell HR and explain how we can reach you with the outcome.

• What is your concern? Describe what happened, when, where and who was involved.
• Have you tried to resolve it already? With whom, and what was the result?
• Are there documents, messages or witnesses that can help? [List.]
• What outcome would you like?
• Is there anything we should do straight away to keep you safe or comfortable at work?
• Signature: ____________

Part B: acknowledgement

Received by: ____________ on ____________ Reference no.: ____________

We have received your concern and it will be looked at by [Name or committee]. You will hear from us by [Date]. Your concern will be treated with care and shared only with the people who need to know.

Handling steps

• Log the concern in the register on the day it is received and give it a reference number.
• Decide the type: pay or leave, manager or colleague behaviour, workplace conditions, harassment, safety or other. Send those that need a special procedure to the right route.
• Acknowledge within [number] working days.
• Assign a person who is not involved in the complaint. Meet the employee, listen and note the facts.
• Hear the other person or people, and look at documents or other evidence.
• Decide the outcome and the action, and record the reasons.
• Tell the employee in person or in writing within [number] working days, and explain how to escalate if they are not satisfied.
• Follow up after [number] weeks to check that the issue has not returned and that no one has faced retaliation.

Part C: register

Keeping it fair and confidential

Timelines, committees and records for specific kinds of complaint are set by law and your sector. Check with your legal adviser before you fix the numbers in this process.

• Restrict the register to HR and the person handling the complaint.
• No one may be treated worse for raising a concern in good faith. Make this explicit in your policy.
• Review the register every [quarter] for patterns by team, manager or category, and report them without names to leadership.
• Keep records for [number] years, or as your legal adviser advises.