Confidential Grievance Complaint
Thank you for taking the time to bring your concerns to us. Please fill out this form to the best of your ability. If you are comfortable, please leave your name and how you want to be contacted to talk about the situation. Reportable grievances may include; your driver texting or driving erratically, assault or harassment of any kind, conflict that you need support to resolve, etc.
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Date of Incident
MM
/
DD
/
YYYY
Name of Complainant
Job Title
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Supervisor
Name of Employee(s) Accused of Grievance
Details of Alleged Incident(s) of Grievance
Witnesses (if any were present)
Comments/Questions/Concerns
How do I want to be contacted about this? (GroupMe DM, in person chat, etc.)
Submit
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