Page 27 - An Indispensible Resource for Being a Credible Activist

HR TOOLS

SAMPLE FEEDBACK REPORT TO HR/OD

(Suggestions and Requests for Intervention)

__ This IS Confidential
__ This is NOT Confidential

IMPORTANT: In the case of concerns, complaints, information, or feedback that
has to do with any issue involving discrimination, harassment, retaliation, acci-
dents, injury, threats, or violence, great care will be taken to protect confiden-
tiality. However, because (Company) takes these issues seriously, discussion with
others will be necessary but will be limited only to those who absolutely must
be involved in order for (Company) to conduct a thorough, prompt, and sound
investigation.

To: ______________________________, HR
From:

Date:
Level of Urgency:

URGENT!
Request response by:________________

Not at all Urgent
Type of Feedback Report:

Complaint
Request for Intervention/Mediation
Suggestion

Policy Question
Assistance Needed

Other: ____________________________
Re:

10 The H R Toolkit