Please describe the concern or incident: When did this occur? Department: Location: Were others involved? —Please choose an option—Not applicableYes Has this happened before? —Please choose an option—YesNoUnsure Did you experience or witness this? —Please choose an option—First-hand experienceSomeone told mePrefer not to say Have you tried to address this with anyone? —Please choose an option—YesNo How has this affected you or your team? What action/support do you want from HR?

What area needs improvement? CommunicationPoliciesWork environmentManagementOther Please describe your feedback: What specific change would help?

What is your suggestion about? Process improvementNew policy/benefitTechnology/toolsTeam buildingOther Describe your suggestion: How might this benefit the workplace?

Describe the policy violation: When and where did this occur? Is this the first time it has happened? —Please choose an option—YesNoUnsure Were others involved? —Please choose an option—Not applicableYes Source of report: —Please choose an option—First-hand experienceSomeone told mePrefer not to say Have you reported this before? —Please choose an option—YesNo What response do you want from HR?

Who would you like to praise? (role/title/team only; no names required): What did this team member do that you’d like to recognize? How did this positively impact you, your team, or the organization?