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When something at work keeps happening, the hardest part is often putting it into words later. A short, factual record fixes that — and it makes a real difference in an accommodation request, a return-to-work plan, or a conversation with HR or a disability-management professional. Fill this in your browser and print it. It never leaves your device.
Private · Printable · Free
Runs entirely in your browser — no sign-in, no tracking, nothing stored. What you write stays on your screen until you print or save it.
Write down what was said and done, not how you read it. Quote where you can. “My manager was dismissive” is an interpretation; “In the 10 AM meeting, my manager said, ‘This is the third time — get it together,’ in front of the team” is a fact.
Memory fades and details blur. Record what happened as soon as you reasonably can after it happens, while you still remember the specifics.
Connect each event to something concrete — what it changed about your day, your ability to do your job, or how you were able to work afterward. That’s what makes a record useful in a later conversation.
This is your personal record. Keep it on a personal device — not a work computer or a shared drive — so it stays yours.
Add an entry for each event. Keep each one short and factual. When you’re done, print it or save it as a PDF — that’s your copy to keep.
This fills in only on your screen — nothing is saved or sent to us, and nothing is stored automatically. Download your PDF before you close this tab, and keep the file on a personal device.
This is a personal record — a way to keep things clear for yourself and for the conversations ahead. It isn’t a legal document, and it isn’t legal advice. If you need advice about your rights, an employment lawyer or your union is the right place to go.
Confidential · for your personal use · CultureIQ Labs never sees what you write here