Bullying Formal Complaint Form

Rice Craig

This Form is for Workers to lay a Formal complaint

Record the details of the complaint below and give the completed form to the appropriate person in the organization. This can be Anne Warner (Practice Manager), your supervising Partner, or Jo McPharlin (designated employee representative), as you may feel safest/best.

Name	Add name here.
When did it happen?	Click here to enter a date.
Where did it occur?	Add location(s) here.
Who was present?	Add name(s) here.
What was said and who said what?	Enter details here.
Why do you think it is bullying?
– It’s unreasonable because:	Explain why it’s unreasonable behavior here.
– It’s repeated because:	Explain why it’s repeated behavior here.
– It’s endangered my health or safety because:	Explain how the behaviour has endangered your health here.
Who witnessed this incident?	Add name(s) here.
How did this incident make you feel?	Explain how the behaviour made you feel here.
How has this incident affected your work?	Explain how the behaviour has affected how you work here.
Have you taken any actions? If so, what?	Choose yes or no with the arrow.
	If yes, detail the actions you’ve taken here.
As a result of this complaint, what do you want to happen?	Add what you want to happen here.