Feedback & Reporting Form
Phone
This field is for validation purposes and should be left unchanged.
Name
First
Last
Anonymous Submission
Yes (keep this anonymous)
No (you can talk to me)
How serious is this?
Just a suggestion
Needs attention soon
Urgent
Critical
What is this about?
Equipment / Tools Issue
Supplies / Inventory
Operational Feedback / Ideas
Employee Feedback / Concern
Safety Concern ⚠️
Customer Issue
Recognition / Praise
Other
EQUIPMENT / TOOLS
Item Name / Description
Issue Type
Broken
Damaged
Missing
Needs maintenance
Unsafe
Item Location
Truck
Shop
Office
Other
Date Noticed
MM slash DD slash YYYY
Upload Photo (2MB Max)
Max. file size: 2 MB.
SUPPLIES / INVENTORY
Supply Name
Current Supply Status
Low
Almost out
Completely out
Request New Tool/Supply?
Yes
No
If NEW tool/supply request → What do you need and why?
Screenshot Of Suggestion
Max. file size: 2 MB.
OPERATIONS / EQUIPMENT FEEDBACK & CONCERNS
What are you giving feedback or concerned about?
Type of issue
Systems / Operations
Equipment / Tools
What's wrong with the tool / item?
Slow
Hard to use
Don't know how to use
Better option available
Ineffective
Other
What's wrong with the system / process?
Wasting Time
Wasting Money
Physical Stress
Mental Stress
Reputation / Branding
Negative Customer Expierence
Negative Employee Experience
Describe what isn’t working well?
How does is impact on your work
Suggested solution or ideas
EMPLOYEE FEEDBACK
Type of Feedback
Praise / Compliment
Coaching / Improvement needed
Conflict
Policy violation
Serious misconduct ⚠️
Behavior Type
Poor work quality
Not following process
Conflict / argument
Disrespect / harassment
Swearing / unprofessional behavior
Possible intoxication
Theft - Time
Theft - Cash
Theft - Supplies / Tools
Sleeping on the job
Other
Person(s) Involved (Names)
What happened?
Date of Incident
MM slash DD slash YYYY
Time of Incident
Hours
:
Minutes
AM
PM
AM/PM
Pictures
Max. file size: 2 MB.
Did you confront / address this with them?
Yes
No
⚠️ SAFETY (HIGH PRIORITY)
Response Time / Priority
Extreme (24hrs)
High (48hrs)
Medium (7 Days)
Low (30 Days)
Safety Issue Description
Is work currently unsafe?
Yes
No
Immediate action needed
CUSTOMER ISSUE
Customer / Job Name
Issue Type
Customer being rude / disrespectful
Customer being aggressive / hostile
Customer discrimination / inappropriate comments
Customer unsafe environment
Customer property hazards (pets, unsafe conditions)
Customer excessive demands (“Karen” behavior)
Other
What went wrong?
Suggested Resolution
BLACKLIST Customer
Make Notes On File
Increase Pricing
Other
RECOGNITION / PRAISE
Who would you like to recognize?
What area are you recognizing them for?
Work quality
Attention to detail
Great attitude
Teamwork
Helping others
Leadership
Going above and beyond
Customer service
Problem solving
Efficiency / productivity
Safety awareness
Training / helping new employees
Representing the company well
Other
What did they do?
Date
MM slash DD slash YYYY
Where did this happen?
Job Site
Truck
Warehouse
Office
Other
Was a customer involved?
Yes
No
How impactful was this?
Small (good job)
Medium (notable effort)
High (above and beyond)
Exceptional (major impact)
Anything else you’d like to add?
Other - Explain