Customer Service Infraction Reporting Form
Report incidents where employee or service interactions did not meet customer service standards. Please provide detailed and accurate information.
Your Name
*
First Name
Last Name
Your Role
*
Please Select
Customer
Employee
Manager/Supervisor
Other
Person(s) Involved (Employee Name or ID, if known)
*
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident
*
Please Select
In-store
Phone
Online Chat
Email
Other
Please describe what happened
*
Which customer service standard(s) were violated?
*
Courtesy/Respect
Responsiveness
Professionalism
Accuracy
Other
Severity of Infraction
*
Minor (inconvenience, no harm)
Moderate (disruption, distress)
Major (significant impact, escalation needed)
Were there any witnesses?
*
Yes
No
Supporting Details (optional: witness names, documentation, etc.)
Requested Follow-Up Action
*
Please Select
No follow-up needed
Contact me for more information
Request investigation
Other
Submit Report
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