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POSH Complaint Form

The POSH complaint form lets an aggrieved woman submit a written complaint of sexual harassment to the Internal Committee. It captures who was involved, what happened, when and where, any witnesses or evidence, and what the complainant wants, so the committee can begin an inquiry promptly.

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[Company Logo][Company Name]

COMPLAINT OF SEXUAL HARASSMENT AT THE WORKPLACE

To,
The Presiding Officer
Internal Committee, [Company Name]
[Company Address]
Email: [IC Email Address]

This form is confidential. You may attach additional sheets wherever space is insufficient.

Part A – Complainant Details

Full Name
Employee ID / Contractor / Visitor
Designation
Department
Work Location
Preferred Contact Number
Preferred Email
Best time and way to contact you

Part B – Respondent Details

Name of Respondent
Designation
Department / Organisation
Work Location
Relationship to you (manager, colleague, client, vendor, other)

Part C – Details of the Incident(s)

Date(s) of incident(s) [DD/MM/YYYY]
Time(s)
Place(s) (office, site, cab, offsite, online platform)
Description of what happened, in your own words
Was this a single incident or repeated?
Have you informed anyone? If yes, whom and when?
Reason for delay, if any, in filing this complaint

Part D – Witnesses and Evidence

Witness Name	Designation / Contact	What they saw or heard
[Witness Name]	[Designation / Phone]	[Brief Note]
[Witness Name]	[Designation / Phone]	[Brief Note]
[Witness Name]	[Designation / Phone]	[Brief Note]

Emails / chat messages / screenshots attached
Call logs or recordings attached
Photographs or CCTV reference provided
Medical or counselling records attached (optional)
Other documents (specify): [Details]

Part E – Relief Requested

Inquiry and appropriate action
Conciliation (without monetary settlement)
Interim relief: transfer of self or respondent
Interim relief: leave
Restraint on respondent from reporting on my work
Other (specify): [Details]

Declaration

I declare that the information given above is true and correct to the best of my knowledge. I understand that the Internal Committee will keep this complaint confidential, will share it with the respondent for reply as part of a fair inquiry, and will conduct proceedings as per the company's POSH policy and applicable law.

Complainant
[Complainant Name]
Signature: ____________
Date: [Date]
Place: [Work Location]

For Office Use – Internal Committee

Complaint Reference No.
Received by (Member Name)
Date and time of receipt
Mode of receipt (in person / email / post / sealed box)
Acknowledgement issued on

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What this template includes

Complainant details with option for preferred contact method, protecting privacy
Respondent details including relationship to the complainant
Incident description with dates, times and locations, the core of the inquiry
Witness list and evidence checklist (messages, emails, CCTV)
Option to request conciliation or interim relief such as transfer
Declaration that the information is true to the best of knowledge
Office-use section for the receiving member to log the date of receipt

When to use it

An employee, intern, trainee or contract worker wants to report sexual harassment at the workplace
A visitor or client's staff reports harassment by your employee at your premises
A committee member helps a complainant who cannot write put the complaint in writing
Making the form available on the intranet and with each committee member

How to customise this template

1Replace the IC email and member names with your current committee details
2Translate the form into the language most of your workforce reads
3Keep copies with each committee member and in a sealed-box near HR
4Add your company's complaint reference numbering format in the office-use section
5Make a fillable Word version for remote and field employees

HR tips

Never make the form a precondition; accept complaints in any written format
Tell complainants they can attach extra pages; long narratives are fine
Do not ask the complainant to hand the form to her reporting manager
Log receipt the same day so time-bound steps can be tracked

This form follows the general scheme of the POSH Act, 2013; time limits for filing and inquiry are set by the Act and rules, so verify current provisions and review the form with a legal adviser.

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Frequently asked questions

Is a specific form mandatory for a POSH complaint?+

The Act requires the complaint to be in writing; it does not insist on a particular form. A standard form simply helps complainants include the details the committee needs.

Can a complaint be filed on behalf of someone else?+

The Act allows certain persons to file a complaint where the aggrieved woman is unable to do so, for example due to physical or mental incapacity. Check the rules for who may file and with what consent.

How many copies of the complaint should be submitted?+

The rules have historically asked for multiple copies along with supporting documents and witness names. Verify the current requirement and tell complainants how many copies to submit.

Will the respondent see the complaint?+

The committee shares a copy of the complaint with the respondent so they can reply; this is part of a fair inquiry. Confidential personal details not needed for the reply can be handled carefully.

All 50 posh, workplace safety & compliance →

[Company Logo][Company Name]
ACKNOWLEDGEMENT OF COMPLAINT
Complaint Ref. No.:
[Reference Number]
Date of Receipt:
[DD/MM/YYYY]
Date of this Letter:
[Date]
STRICTLY CONFIDENTIAL

To,
[Complainant Name]
[Designation], [Department]
[Work Location]
Subject: Acknowledgement of your complaint dated [DD/MM/YYYY]
Dear [Complainant Name],

The Internal Committee of [Company Name] acknowledges receipt of your written complaint dated [DD/MM/YYYY], received on [DD/MM/YYYY] through [in person / email / post]. Your complaint has been registered under reference number [Reference Number]. Please quote this number in all future communication with the committee.
What Happens Next
1. The committee will share a copy of your complaint with the respondent within [Number] working days, as required for a fair inquiry.
2. The respondent will be given an opportunity to submit a reply and documents.
3. Before starting the inquiry, you may ask the committee to attempt conciliation. This is entirely your choice and no monetary settlement can form the basis of conciliation.
4. If no conciliation is sought or it does not succeed, the committee will hold an inquiry, hear both parties and witnesses, and complete it within the period prescribed under the current rules.
5. You will be informed in writing of hearing dates and of the outcome.
Letter · Word
POSH Complaint Acknowledgement
Download .docx
[Company Logo][Company Name]
POSH TRAINING FEEDBACK FORM
Session Date:
[DD/MM/YYYY]
Trainer:
[Trainer Name]
Batch / Location:
[Work Location]
Your feedback helps us improve. Writing your name is optional. Please do not use this form to report a complaint; contact the Internal Committee at [IC Email Address] or any committee member instead.
Section A – About You (optional)
Name (optional)
Department
Role level (Staff / Supervisor / Manager)
Employee or contract staff
Section B – Rate the Session (1 = Poor, 5 = Excellent)
Aspect 1 2 3 4 5
Content was clear and easy to understand
Examples were relevant to our workplace
Trainer handled questions well
Duration was appropriate
Language of delivery suited me
Form · Word
POSH Training Feedback Form
Download .docx
[Company Logo][Company Name]
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
Policy · Word
POSH Policy
Download .docx

Name (optional)
Department
Role level (Staff / Supervisor / Manager)
Employee or contract staff

[Company Logo][Company Name]

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.

Role	Name	Designation / Organisation	Phone	Email
Presiding Officer	[Member Name]	[Designation] (senior woman employee)	[Phone]	[Email]
Member	[Member Name]	[Designation]	[Phone]	[Email]
Member	[Member Name]	[Designation]	[Phone]	[Email]
External Member	[Member Name]	[NGO / Organisation Name]	[Phone]	[Email]

Tenure

Notice · Word

POSH Committee Constitution Letter

Download .docx

[Company Logo][Company Name]
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
Letter · Word
POSH Committee Member Appointment
Download .docx
[Company Logo][Company Name]
POSH INQUIRY CHECKLIST
Complaint Ref. No.:
[Reference Number]
Date of Receipt:
[DD/MM/YYYY]
Presiding Officer:
[Presiding Officer Name]
Target Completion:
[DD/MM/YYYY]
Phase 1 – Intake (Presiding Officer)
- Complaint received in writing and logged in POSH register
- Acknowledgement issued to complainant with reference number
- Required copies and supporting documents received
- Each member has declared no conflict of interest, or recused
- Quorum for this case confirmed, including external member
- Case file opened and stored securely
Phase 2 – Conciliation (Committee)
- Complainant informed of option of conciliation
- Complainant's written choice recorded
- If conciliation: settlement recorded without any monetary element
- Copies of settlement given to both parties and employer
- If no conciliation or it fails: inquiry initiated
Phase 3 – Notice and Reply (Committee)
Checklist · Word
POSH Investigation Checklist
Download .docx
[Company Logo][Company Name]
INQUIRY REPORT OF THE INTERNAL COMMITTEE
Complaint Ref. No.:
[Reference Number]
Complainant:
[Complainant Name], [Designation]
Respondent:
[Respondent Name], [Designation]
Date of Complaint:
[DD/MM/YYYY]
Date of Report:
[Date]
Classification:
Strictly Confidential
1. Committee Members Who Conducted the Inquiry
Name Role Sittings Attended
[Member Name] Presiding Officer [Number]
[Member Name] Member [Number]
[Member Name] Member [Number]
[Member Name] External Member [Number]
2. Summary of the Complaint
The complainant alleged that [brief factual summary of each allegation, with dates and places]. The complainant sought [relief requested].
3. Reply of the Respondent
Report · Word
POSH Investigation Report
Download .docx
[Company Logo][Company Name]
NOTICE OF HEARING – INTERNAL COMMITTEE
Ref. No.:
[Reference Number]
Date:
[Date]
Classification:
Confidential
To,
[Employee Name]
[Designation], [Department]
Employee ID: [Employee ID]
[Work Location]
Subject: Notice to appear before the Internal Committee in Complaint No. [Reference Number]
Dear [Employee Name],

The Internal Committee of [Company Name] is conducting an inquiry into Complaint No. [Reference Number] under the Sexual Harassment of Women at Workplace (Prevention, Prohibition and Redressal) Act, 2013. You are requested to appear before the committee in your capacity as [complainant / respondent / witness] as per the details below.
Particular Details
Date [DD/MM/YYYY]
Time [Time]
Venue [Meeting Room, Floor, Building] / Video link: [Link]
Expected Duration [Number] hours
Contact for queries [Member Name], [Phone]
Please Bring
Notice · Word
POSH Hearing Notice
Download .docx