Staff Complaints Form Updated: 26 April 2018 Page 1 of 4
Complainant Details
First Name
Surname
Staff Number
Phone
JCU Email Address
Supervisor/Manager Details:
Your Supervisor’s name:
Your Dean/Director’s name:
Representative Details (if required):
You may have a Representative support you. A Representative is a person to assist, accompany and support them in their participation in
matters relating to a complaint in line with the Discrimination, Bullying and Harassment Policy and Procedure for Staff and Affiliates. A
representative may be a staff member; or delegate or staff member of a union that is negotiated in the Enterprise Agreement and not a
practicing solicitor or barrister.
Representative’s Name:
Representative’s Position:
Relationship to you:
Important Information
Information about managing formal complaints is outlined in the Discrimination, Bullying and Harassment Policy and
Complaint Procedure for Staff and Affiliates. You can also speak to an Equity Contact Officer who can provide
information and referral options in relation to your issue or complaint.
The intention of this form is to help define your complaint, and inform what you have done to resolve the issue prior
to making a formal complaint. It will provide you with guidance on the types of information needed to resolve your
complaint. Please note; if there is more than one complainant, each complainant must complete a separate form.
Once completed, please submit this form to your supervisor / next level manager and to your divisional Human
Resources Business Partner. Acknowledgement of your complaint will be in writing from the supervisor/next-level
manager.
Discrimination, Bullying and Harassment Staff
and Affiliates Formal Complaint Form
Human Resources Directorate
Please refer to the Discrimination, Bullying and Harassment Policy and Discrimination, Bullying
and Harassment Complaint Procedure for Staff and Affiliates.
Staff Complaints Form Updated: 26 April 2018 Page 2 of 4
Complaint Statement
Please provide a typed statement about your complaint that includes, where relevant:
1) A description of the event/s or incident/s which occurred:
Please provide a clear explanation of whom you are complaining about and what behaviour or types of behaviour you are complaining about.
You should also include how you have been adversely and unjustifiably impacted by the behaviour/s. Please outline the event/s or incident/s in
chronological order; stating dates, times and locations as well as the names of those involved, or who witnessed the event/s or incident/s.
2) Detail any evidence you have to support each event/s or incident/s in your complaint:
Please provide a numerical list of your evidence, referring to this as you discuss the event/s or incident/s throughout your statement and attach
this evidence to your complaint. Please refer to any evidence you know of but do not possess and who would possess this evidence. If you do
not have any evidence please list as not applicable.
3) Include any steps that you have already taken to try to resolve the complaint (if relevant)
Please provide a list of your actions to date including, if applicable:
whom you have taken your complaint to
why you think the complaint has not been resolved informally and
why you think a formal complaint is required to resolve the matter.
Please provide an overview of the advice you have received to date and if you attempted to resolve the matter informally what was the
outcome? If you have not taken any steps to resolve the matter informally, please provide information as to why.
Staff Complaints Form Updated: 26 April 2018 Page 3 of 4
4) Describe what behaviours (as per the policy) were demonstrated by the person against whom you are making
the complaint
(E.g. If the complaint is discrimination, under what attribute are you being discriminated against?).
5) Provide the name and contact details of any witness or other person who may support your complaint and or
who you spoke to about your complaint.
Include why you believe they are a witness. If you don’t have any witnesses please list as not applicable.
6) Provide a summary of the basis of the complaint:
What do you reasonably think should have happened, been provided to you, or you expected?
7) What outcome/s are you are seeking?
What you would like to see as an outcome of your complaint cannot be guaranteed by JCU, however your complaint will be addressed within
JCU’s legal obligations, policies and procedures.
Staff Complaints Form Updated: 26 April 2018 Page 4 of 4
Your Agreement:
In submitting this complaint, I agree that:
I have read the Discrimination, Bullying and Harassment Policy and Complaint Procedure for Staff and
Affiliates.
I have written a clear and concise outline of the complaint and the resolution I would like to see and have
attached all relevant evidence.
The information I have provided in this document is a true reflection of my experience and has not made for
frivolous or vexatious purposes.
I understand that complaints found to be intentionally misleading or made for the purposes of causing harm
may result in misconduct proceedings.
I will conduct myself appropriately, showing courtesy and respect when dealing with staff.
I will keep the process confidential, sharing only with my representative/support person, and those
managing this process.
Your signature:
Date:
Submitting Your Complaint
Once completed and signed, please send your complaint with attachments via email to:
1) your Supervisor or Next Level Manager and;
2) Your divisional Human Resources Consultant or Human Resources Business Partner.
click to sign
signature
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