Employee Relations Investigation Checklist Form
Please complete this checklist to document and track the investigation of an employee relations complaint or incident.
Incident/Complaint Summary
*
Name(s) of Involved Employee(s)
*
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
*
Department
*
Reporting Party Details (Name and Contact Info)
*
Concise Description of What Happened
*
Immediate Actions Taken (check all that apply)
Separated involved parties
Secured evidence
Notified management
Medical attention provided
Other
Evidence and/or Witnesses (list names, attach files as needed)
Investigator Assigned
*
Investigation Status
*
Please Select
Open
In Progress
Closed
Submit Checklist
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