Updated: November 26, 2025
Employer Retaliation Incident Log PDF (Free Template)
Document each retaliatory action after reporting harassment, discrimination, safety issues, or wage problems so you have a clean, time-stamped log for HR, government complaints, or court.
Use the free PDF generator
Add incidents, impacts, and witnesses privately in your browser, then download the PDF to share with HR, an attorney, or an agency.
When to use a retaliation log
Keep a detailed record after any protected complaint, including:
- Harassment or discrimination complaints made to HR or management.
- Safety or OSHA complaints about workplace hazards.
- Wage or overtime complaints, including state labor agency filings.
- Reports of retaliation for whistleblowing or protected concerted activity.
What to record in each incident
- Date of the incident.
- What changed or happened (schedule cuts, write-ups, reassignment, demotion).
- Who was involved and any witnesses.
- How it affected you (hours cut, pay lost, duties changed).
- Your response or follow-up, including who you told.
How this helps with HR, a lawyer, or a government agency
A clear log makes it easier to show patterns, timelines, and impacts. You can attach the PDF to HR complaints, EEOC/DFEH filings, OSHA submissions, or attorney consultations.