All templates
Employee Relations
Whistleblower / Complaint Form
A confidential form for employees to report misconduct, violations, or ethical concerns safely, with optional anonymity and supporting evidence documentation.
CONFIDENTIAL COMPLAINT FORM
This form can be submitted anonymously. All reports will be treated confidentially.
Date: [Date]
Reporting Method: ☐ Named ☐ Anonymous
Your Name (optional): [Name]
Your Role: [Role]
Your Contact (optional): [Email/Phone]
COMPLAINT DETAILS
Type of Concern:
☐ Harassment or Discrimination
☐ Unethical Behaviour
☐ Policy Violation
☐ Safety Concern
☐ Financial Misconduct
☐ Conflict of Interest
☐ Retaliation
☐ Other: [Specify]
Details of the Concern:
Please describe what happened, including:
• Date(s) and location(s) of incident(s)
• People involved (names, roles)
• What specifically occurred
• Any witnesses
[Detailed description of the concern]
SUPPORTING EVIDENCE
☐ I have attached documents/evidence
☐ There are witnesses who can corroborate
☐ I do not have evidence at this time
PREVIOUS ACTION
Have you raised this concern elsewhere?
☐ No
☐ Yes — with [Name/Department] on [Date]
Outcome: [Outcome]
DECLARATION
I confirm the information provided is true to the best of my knowledge. I understand that making a false report may result in disciplinary action.
Signature (if named): ___________________ Date: _______
FOR HR USE ONLY
Received by: ___________________ Date: _______
Case #: [Number]
Acknowledgement sent: ☐ Yes — Date: [Date]
Investigation assigned to: [Name]
Status: [Open / In Progress / Closed]