Informal Report of Unreasonable Behaviour

Rice Craig

This Form is for Workers to Informally Report Behaviour that has Upset them

This form is for workers to informally report behavior that has upset them.

It should be noted that Bullying is a breach of the Code of Conduct rule 10.1 and is required to be reported to the NZLS. This may be kept in mind during any informal complaint process.

Record the details of the behavior below and give the completed form to the appropriate person in the organization.  This can be anyone in a supervisory role. 


Add name here.

When did it happen?

Click here to enter a date.

Where did it

Add location(s)

Who was

Add name(s)

What happened?

Who did what?

Enter details

How did this behaviour
make you feel?

Explain how the
behaviour made you feel here.

How has this behaviour
affected your work?

Explain how the
behaviour has affected how you work here.

Have you taken
any actions? If so, what?

Choose yes or
no with the arrow.


If yes, detail
the actions you’ve taken here.

As a result of
this report, what do you want to happen?

Add what you
want to happen here.