Employee Complaint Form

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Post Office Box 997
Horry County
Conway, SC 29528-0296
Human Resources Department
Phone: (843) 915-5230
Risk Management
ND
1301 2
Avenue
Fax: (843) 915-6230
E-mail:
Conway, SC 29526
EMPLOYEE COMPLAINT FORM
Name of Complainant: _______________________________________________________________
Department: _____________________________________ Phone: ____________________________________
State Complaint: _____________________________________________________________________________
_____________________________________________________________________________________________
Synopsis of facts giving rise to Complaint (include dates, times, be specific) Attach documentation:
_____________________________________________________________________________________________
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_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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Policy or procedure allegedly violated: ___________________________________________________________
_____________________________________________________________________________________________
What specific role do you want HR to play: _______________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
___________________________________________________
___________________________
Signature
Date

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