Employee Feedback Resolution Acknowledgment Form
Please review the resolution to your feedback, confirm your acknowledgment, and provide any additional comments.
Employee Full Name
*
First Name
Last Name
Department
*
Please Select
Human Resources
Finance
Operations
Sales
Marketing
IT
Other
Employee Email Address
*
example@example.com
Feedback Reference Number or ID (if applicable)
Date of Original Feedback Submission
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Brief Summary of Your Original Feedback
*
Resolution Provided (Summary)
*
Date of Resolution
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Are you satisfied with the resolution provided?
*
Yes, I am satisfied
No, I am not satisfied
Partially satisfied
Please provide any additional comments or suggestions (optional)
Employee Signature
*
Submit Acknowledgment
Submit Acknowledgment
Should be Empty: