Supervisor Complaint Reporting
Please fill out the following form to report Supervisor behaviour that you found to be unbecoming, risky or inappropriate. Please note that any supervisor or managerial behaviour that constitutes sexual harassment or any other form of harassment should be reported to the executive immediately at (416) 845-0597. Thank you very much for your time your input is extremely valuable. Please note that we cannot guarantee anonymity or security due to the nature of this online form. We intend to gather this information to identify trends and suggest improvement for managerial relations. The information submitted in this form may be shared with management. If you wish to make a confidential complaint please call (416) 845-0597.
Your name and partner's name (if applicable):
Your answer
Date of incident or estimate: *
MM
/
DD
/
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Time of incident or estimate:
Time
:
What position does the managerial staff person hold? *
Name of managerial staff:
Your answer
Was this related to a staging call? *
Have you had previous difficult interactions with this supervisor?
Did you feel you were put in harm's way or an unnecessarily risky situation because of this individual?
Nature of complaint (select all that apply)
What was the context and setting of the interaction?
WSIB
Stress Leave
Attendance management
Patient care
Attitude
Lunch/meal break issue
End of shift
Offload delay
Disagreement
At hospital
In front of patient
In front of bystanders
In front of peers
In private
At station
On phone
Please provide a description of the event. Do not include names (other than yours, and the Supervisor), addresses or any other confidential information. *
Your answer
Going forward, did this interaction negatively affect your working relationship with the supervisor?
Are there any other comments or suggestions, you would like to add?
Your answer
Did you report the issue to the individual's superior?
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