Treat safety concerns as urgent
A concern about ratios, a broken gate or a medication mix-up should trigger an immediate walk-through — the form is the record, not the response.
Free templateStaff Management
Staff Concerns Form Template
A one-page Employee Concern/Complaint Form: the employee describes the concern, how it has affected their work and what the company could do about it, and the office records the date received, the action plan and the director’s signature.
- Format
- Printable PDF · US Letter
- Pages
- 1
- Best for
- Directors · all staff
- Updated
- Sept 2026
No sign-up required. Print it and share it with your team — it’s free for any child care program to use.
What’s inside
What was raised, what was asked for, and what happened next
- Header detailsName of the company, name of employee, date of complaint, and a ‘circle one’ choice between Concern and Complaint.
- Description of the concernThe nature of the complaint or concern in detail, including the names of the individuals involved, witnesses and any proof.
- Impact on workHow the incident has affected the employee’s ability to work effectively.
- Suggested actions and preventionWhat the company could do to deal with it, what would avoid a repeat, any additional comments, and the employee’s signature.
- For Office Use OnlyDate received, action plan, completion date and director signature.
How to use it
Four steps to put it to work this week
- 1Make the form easy to findStaff room, shared drive and the staff app. A form nobody can find is a policy nobody trusts.
- 2Acknowledge within two working daysEven ‘I’ve received this and we’ll meet Thursday’ matters.
- 3Meet, then write the action planComplete the office-use section together where possible so the actions are agreed, not imposed.
- 4Follow up by the completion dateClose the loop, sign it off, and file the form in the staff member’s HR file.
Tips from operators
What centers that use this well do differently
Learned the hard way across 3,000 child care spaces — and from the directors and educators who join our Lunch & Learns and Learning Labs.
Look for patterns quarterly
Three workload concerns from one room in a term is a staffing problem, not three individual issues.
Thank people for raising things
The centers with the fewest crises are the ones where staff feel safe flagging small things early.
Do it digitally in ChildFriendly Pro
Staff files, hours and reviews that keep themselves current
ChildFriendly Pro keeps every educator’s certifications, clearances, PD hours, timecards and review notes in one HR file — with expiry alerts, ratio-aware scheduling and wage top-up hours grouped by level.
- Kiosk clock-in with break and overtime rules
- Certification and clearance expiry alerts
- Direct-care hours by level for wage-enhancement claims
FAQ
Questions about the Staff Concerns Form
Can’t find your answer? Chat with a real person who has run a child care center.
Read more FAQsIs a staff concerns form required?
Most jurisdictions require a workplace harassment or grievance procedure, and licensing expects a way for staff to report safety issues. This form is a practical way to meet both — check the wording against your provincial or state employment standards.
Can concerns be anonymous?
You can allow it, but anonymous concerns are harder to resolve. A common compromise: the form is confidential (only the director sees it), not anonymous.
Where should completed forms be stored?
In the staff member’s HR file, separate from child records, with access limited to the director and owner. If you use a digital HR file cabinet, set the permissions accordingly.
What if the concern is about the director?
Your policy should name an alternate — the owner, a board member or an HR contact. The form only has a director signature line, so tell staff who the alternate is when you hand it out.
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