[Company Logo][Company Name]
STATEMENT REGARDING ALLEGED MISCONDUCT
- Case Ref. No.:
- [Reference Number]
- Statement taken on:
- [DD/MM/YYYY], [Time]
- Recorded by:
- [HR Name]
Part A – Person Giving the Statement
| Full Name | |
|---|---|
| Employee ID (if employee) | |
| Designation and Department | |
| Contact Number | |
| Capacity: Witness / Complainant / Employee concerned / Other |
Part B – Incident Details
| Date of incident (DD/MM/YYYY) | |
|---|---|
| Approximate time | |
| Exact location | |
| Name(s) of the person(s) involved | |
| Other persons present |