Grievance / Complaint Reporting Form Date & Time of Complaint Name of Complainant / Grievant (leave blank if anonymous) Individual or Company Consent to use individual identity You can use my name but do not use it in public. You can use my name publicly. You cannot use my name at all (Anonymous) Consent to use company name Use company name privately Use company name publicly Do not use company name at all Contact Information Phone Email Postal Address Location Preferred language & method of communication Nature of Grievance Environmental Social Occupational & Community H&S GBV / SEA / SH Labour / Contractual Other (specify) Description of the grievance Attach supporting documents (optional) Location / Site Status of Occurrence One-time Happened more than once Ongoing issue Expected action from KDEAP Submit Grievance