Medical Fitness Certificate

CERTIFICATE OF COMPLETION – POSH AWARENESS PROGRAMME

Certificate No.:

[Reference Number]

Date of Issue:

[Date]

[Company Name]
[Company Address]

This is to certify that

[Employee Name]
[Designation], [Department]
Employee ID: [Employee ID]

has successfully completed the [POSH Awareness Programme / POSH Sensitisation for People Managers / Training for Internal Committee Members] on the prevention, prohibition and redressal of sexual harassment at the workplace, conducted on [DD/MM/YYYY] for a duration of [Number] hours through [classroom / online] mode at [Work Location].

The programme covered the meaning of sexual harassment and the workplace under the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013; the company's POSH policy; the role of the Internal Committee; the complaint and inquiry process; confidentiality; protection against retaliation; and the responsibilities of every employee in maintaining a safe and respectful workplace.

PRE-EMPLOYMENT MEDICAL EXAMINATION FORM

Form No.:

[Reference Number]

Date:

[DD/MM/YYYY]

Clinic / Doctor:

[Clinic Name]

Part 1 – Candidate Details (to be filled by HR)

Part 2 – Health Questionnaire (to be filled by Candidate)

Part 3 – Clinical Examination (Doctor)

ANNUAL / PERIODIC MEDICAL EXAMINATION FORM

Form No.:

[Reference Number]

Examination Year:

[Year]

Date:

[DD/MM/YYYY]

Examining Doctor:

Dr. [Doctor Name]

Section 1 – Employee and Exposure Details

Section 2 – Interval Health History

Section 3 – Year-on-Year Comparison

RETURN-TO-WORK MEDICAL CLEARANCE

Ref. No.:

[Reference Number]

Date:

[Date]

Part A – Employee and Absence Details (HR)

Part B – Medical Clearance (Treating Doctor)

I have examined [Employee Name] on [DD/MM/YYYY] and, considering the job demands described by the employer as [job demands], certify that the employee is:

• Fit to resume full duties from [DD/MM/YYYY]
• Fit to resume with restrictions listed below from [DD/MM/YYYY]
• Not yet fit; review on [DD/MM/YYYY]

POLICY ON PREVENTION OF SEXUAL HARASSMENT (POSH)

Policy No.:

[Reference Number]

Version:

[Version Number]

Effective Date:

[Date]

Policy Owner:

Human Resources / Internal Committee

1. Purpose

[Company Name] is committed to a workplace free of sexual harassment. This policy is framed under the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013 and its Rules, to prevent sexual harassment and provide a fair redressal mechanism.

2. Scope

It applies to all employees, interns, trainees, consultants, contract staff and visitors at all locations of the company, including [Work Location]. 'Workplace' includes offices, sites, company transport, places visited during work, and work-related online spaces. As company policy, [the protections are extended to employees of all genders].

3. Definitions

ORDER CONSTITUTING THE INTERNAL COMMITTEE

Ref. No.:

[Reference Number]

Date:

[Date]

Effective From:

[DD/MM/YYYY]

Applicable To:

[Work Location / All Locations]

[Company Name]
[Company Address]

Subject: Constitution of the Internal Committee under the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013

In accordance with the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013 and the rules framed under it, the management of [Company Name] hereby constitutes the Internal Committee (IC) for [Work Location / All Locations] with effect from [DD/MM/YYYY]. The committee shall receive and inquire into complaints of sexual harassment at the workplace and recommend action in a fair, timely and confidential manner.

Tenure

APPOINTMENT AS PRESIDING OFFICER – INTERNAL COMMITTEE

Ref. No.:

[Reference Number]

Date:

[Date]

To,
[Employee Name]
[Designation], [Department]
Employee ID: [Employee ID]
[Work Location]

Subject: Appointment as Presiding Officer of the Internal Committee

Dear [Employee Name],

We are pleased to inform you that the management of [Company Name] has appointed you as the Presiding Officer of the Internal Committee constituted under the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013, vide order no. [Reference Number] dated [Date]. This appointment recognises your seniority, integrity and the trust that colleagues place in you.

Your Responsibilities

1. Chair meetings of the Internal Committee and ensure the required quorum is present.
2. Receive complaints, guide complainants on the process and record them properly.
3. Lead inquiries in line with principles of natural justice, giving both parties a fair hearing.
4. Consider requests for conciliation where the complainant asks for it, without monetary settlement.
5. Ensure the inquiry is completed within [Number] days or the period prescribed under current rules.
6. Sign and submit the inquiry report and recommendations to the employer.
7. Contribute to the annual report and awareness programmes.

APPOINTMENT AS MEMBER – INTERNAL COMMITTEE

Ref. No.:

[Reference Number]

Date:

[Date]

Member Category:

[Employee Member / External Member]

To,
[Member Name]
[Designation / Organisation Name]
[Address]

Subject: Nomination as Member of the Internal Committee

Dear [Member Name],

With reference to the order constituting the Internal Committee of [Company Name] (Ref. [Reference Number], dated [Date]), we are pleased to nominate you as a member of the committee for [Work Location / All Locations] under the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013.

For employee members: You have been nominated in view of your commitment to the cause of women, and your experience in [social work / legal knowledge / employee relations]. Committee work will be treated as part of your official duties.

For the external member: You have been nominated in view of your association with [NGO / Organisation Name] and your familiarity with issues relating to sexual harassment. You will be paid an honorarium of ₹[Amount] per sitting along with reimbursement of travel expenses of up to ₹[Amount], payable within [Number] days of each sitting.

Terms of Membership