Workplace Relationship Disclosure Form

This form is confidential and must be submitted to your Line Manager or a Director.

Your Full Name:

Job Title / Department:

Email Address:

Line Manager’s Name:

Relationship Details

Name of person you have a relationship with:

Their Job Title / Department:

Nature of the Relationship:

Are you in a direct reporting line?
Yes
No
Unsure

Do you work closely together?
Yes
No
Occasionally

Declaration

By submitting this form, I confirm that I have read and understood the Personal Relationships at Work Policy. I am disclosing this relationship in accordance with company policy.

Date: