Confidential

Formal grievance

This is the record an investigator, a mediator, or a lawyer will read first. Capture incidents with dates and locations, name the people involved, log every prior attempt to resolve it, and close with a signed acknowledgement.

Grievance completeness25%

12 items outstanding

Employee information

Name

Department

Role

Date

Nature of the grievance

Specific incidents, dates, locations and individuals involved. Facts, in order.

Describe the grievance in detail

When did this first occur

Location

Individuals involved

Has this issue occurred before

Were there any witnesses

Previous actions taken

Have you attempted to resolve this informally

Have you previously reported this to a supervisor, HR or another authority

Desired resolution

What outcome are you seeking, for example a policy change, mediation or corrective action

Are you open to mediation or a facilitated discussion

Supporting evidence

List what is attached. Upload the files into this drive section after filing.

Documents, emails or communications provided

Acknowledgement

The employee confirms the information provided is accurate to the best of their knowledge, understands the grievance will be reviewed under company policy, and may be contacted for further discussion.

Once this is filed, open the investigation record and start the clock on interviews.

Open an investigation

Live document

Set company

Company and PEO references fill in from your company profile.

FORMAL GRIEVANCE PROTOCOL

CONFIDENTIAL HUMAN RESOURCES RECORD

Company:[Company]

PEO partner:[PEO]

EMPLOYEE INFORMATION

Name:______

Department:______

Role:______

Date:2026-08-30

NATURE OF THE GRIEVANCE

______

Dates of the incidents:______

Location:______

Individuals involved:______

Has this issue occurred before: ______

Were there any witnesses:______

PREVIOUS ACTIONS TAKEN

Attempted to resolve this informally: ______

Previously reported to a supervisor, HR or another authority: ______

DESIRED RESOLUTION

______

Open to mediation or a facilitated discussion: ______

SUPPORTING EVIDENCE

______

ACKNOWLEDGEMENT AND SIGNATURE

By signing below, I confirm that the information provided is accurate to the best of my knowledge. I understand that my grievance will be reviewed according to company policies, and I may be contacted for further discussion.

Employee Signature:____________________ Date: ____________