Q01
Message
All templates
Employee Complaint Intake and Follow-Up Survey
A confidential intake form for employees to document a workplace complaint or concern, capturing what happened, who's involved, severity, and desired resolution. An AI follow-up interview gently reconstructs the specific timeline and details so HR gets an actionable, well-documented account instead of a vague summary.
Sample questions
A preview of what’s in the template. Every question is editable before you launch.
15 questions · ~8 min
Q02
Multiple ChoiceRequired
What type of issue are you reporting?
- Harassment or discrimination
- Bullying or disrespectful behavior
- Unsafe working conditions
- Unethical or dishonest conduct
- Policy or procedure violation
- Compensation, scheduling, or workload dispute
- Retaliation for a prior report
Q03
Multiple Choice
Who is this complaint primarily about?
- My direct manager
- A manager or leader outside my team
- A coworker on my team
- A coworker in another team
- A vendor, client, or external contact
- Multiple people
- Prefer not to say
Q04
Date
When did the most recent incident related to this complaint occur?
Q05
Multiple ChoiceRequired
In the last 6 months, how often has this type of incident occurred?
- This is the first time
- A few isolated times
- Repeatedly, on and off
- Constant or ongoing
Q06
Opinion ScaleRequired
How severe do you consider this issue to be?
Scale: 1 – 5
Min:Minor concernMax:Critical, needs urgent action
Q07
Multiple ChoiceRequired
Have you previously reported this issue to anyone?
- No, this is the first report
- Yes, to my manager
- Yes, to HR
- Yes, to another leader
- Yes, informally to a colleague
Q08
MatrixRequired
Thinking about this situation, how much do you agree with each statement?
4 rows × 5 columns
- I feel safe raising this concern
- I believe appropriate action will be taken
- This has affected my ability to do my job
- This has affected my wellbeing outside of work
Columns: Strongly disagree · Disagree · Neutral · Agree · Strongly agree
Q09
Long TextRequired
Please describe what happened, including approximate dates, the people involved, and any witnesses.
Q10
Multiple ChoiceRequired
What outcome are you hoping for from this report?
- A formal investigation and corrective action
- A mediated conversation between the parties
- A change to a policy or process
- I mainly wanted this documented for the record
- I'm not sure yet
Q11
AI Interview
Reconstruct the specific timeline of the most recent incident described: what was said or done, in what order, who was present, and how the respondent and others reacted in the moment. Probe for concrete details (exact words, dates, locations, any documentation like emails or messages) rather than general impressions. If the respondent indicates this is repeated or ongoing, ask them to walk through one other clear example. If they seem hesitant or vague about naming people involved, reassure them once about confidentiality and gently ask again before moving on.
Q12
File upload
If you have any supporting documents, screenshots, or messages related to this complaint, you may upload them here (optional).
Q13
Dropdown
Which department do you work in? (Optional, helps HR route this report)
- Sales
- Marketing
- Engineering or Product
- Operations
- Customer Support
- Finance
- Human Resources
- Other
- Prefer not to say
Q14
Multiple Choice
How long have you worked at the company?
- Less than 6 months
- 6 months to 2 years
- 2 to 5 years
- More than 5 years
- Prefer not to say
Q15
Message
Thank you for trusting us with this report. It will be reviewed confidentially by HR, and where appropriate, someone will follow up with you directly about next steps.
What’s included
AI follow-ups
Adaptive probes on open-ended answers that pull out detail a static form would miss.
Attention checks
Built-in safeguards against rushed answers and low-quality respondents.
AI-drafted copy
Wording, ordering, and branching written by the AI — tuned to your research goal.
Auto report
Themes, quotes, and a plain-English summary write themselves once responses come in.
How it compares
We reviewed the closest templates from other survey tools. Here’s what they do well — and where this template goes further.
Why this template
- Captures structured intake details (issue type, parties involved, severity, frequency, prior reports) alongside a matrix of agreement statements and a detailed open narrative, so HR gets both quantifiable and qualitative context.
- An AI follow-up interview specifically reconstructs the timeline of the most recent incident (what happened, who was involved, in what order), turning a vague complaint into an actionable, well-documented account.
- Supports file uploads for supporting evidence (screenshots, messages, documents) directly within the same flow.
- Opens and closes with confidentiality-focused chat messages, and collects optional routing details (department, tenure) without forcing disclosure that could feel invasive.
Jotform
Employee Formal Complaint Form TemplateA standard fielding-ready form builder template for capturing formal employee complaints, likely with fields for incident details and parties involved. It's a static form-fill experience rather than an interview, so any follow-up clarification depends entirely on how HR staff manually review free-text answers.
What it does well
- Ready-to-use, customizable form builder with drag-and-drop fields
- Wide template library and integrations typical of Jotform's ecosystem
- Simple to deploy for basic complaint intake
Where it falls short
- No adaptive AI follow-up to probe vague or incomplete incident descriptions
- No automated per-response quality scoring to flag weak submissions
- No transparent, published interview prompts or methodology
SurveyMonkey
Employee Complaint Form TemplateA conventional survey template for collecting employee complaints using SurveyMonkey's standard question types. It's built for one-shot data collection and reporting, not for reconstructing an incident timeline through dialogue. Strong for aggregate reporting, less suited to building a single well-documented case file.
What it does well
- Established survey platform with solid reporting/analytics dashboards
- Easy to distribute and collect responses at scale
- Familiar UI for respondents and HR teams alike
Where it falls short
- No adaptive AI interview to reconstruct incident timelines or dig into specifics
- No voice AI or guided screen-share task options
- No automated quality scoring of individual responses
SurveySparrow
Free Employee Complaint Form TemplateA free, conversational-style form template aimed at making complaint intake feel more human than a plain form. It likely offers a chat-like UI for question flow, but this is scripted branching rather than a true adaptive AI interview that follows up dynamically based on what the employee actually writes.
What it does well
- Conversational, chat-style interface that can feel friendlier than a static form
- Free to use, lowering the barrier to entry
- Mobile-friendly presentation typical of SurveySparrow forms
Where it falls short
- Conversational UI is pre-scripted, not a genuine adaptive AI follow-up that reacts to response content
- No automated quality scoring of individual responses
- No published, transparent methodology for how follow-up questions are generated
Typeform
Employee Complaint Form TemplateA polished, one-question-at-a-time form template known for good respondent experience and design. It's still a fixed sequence of questions defined at build time, so it can't dynamically reconstruct a specific incident timeline the way a follow-up interview can.
What it does well
- Clean, one-at-a-time question flow with strong visual design
- Good completion rates typical of Typeform's UX
- Easy embedding and sharing across channels
Where it falls short
- Static logic-jump branching only, no adaptive AI probing based on free-text answers
- No automated per-response quality scoring
- No voice AI interview option or guided screen-share tasks
Ready to launch?
Open this template in the editor. Every part is yours to change before the first respondent sees it.