Free form template · Word

POSH Employee Statement

The POSH employee statement is a written statement a complainant or respondent submits to the Internal Committee in their own words. Respondents use it as their formal reply to the complaint; complainants use it to give a fuller account. It sets out a chronology, responses to each allegation and supporting documents.

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[Company Logo][Company Name]

WRITTEN STATEMENT TO THE INTERNAL COMMITTEE

Complaint Ref. No.:: [Reference Number]
Date of Submission:: [DD/MM/YYYY]
Classification:: Confidential

Instructions: Write in your own words. Stick to facts with dates and places. This statement will be shared with the other party for response as part of a fair inquiry. Attach extra sheets if needed.

Section 1 – Details of the Person Making the Statement

Name
Employee ID
Designation
Department
Reporting Manager
Work Location
Role in the case (Complainant / Respondent)

Section 2 – Type of Statement

Reply to complaint (respondent)
Additional statement (complainant)
Rejoinder to the other party's statement
Response to witness statement(s)
Final written submission

Section 3 – Chronology of Events

Date	Time	Place	What happened	Who was present
[DD/MM/YYYY]	[Time]	[Place]	[Description]	[Names]
[DD/MM/YYYY]	[Time]	[Place]	[Description]	[Names]
[DD/MM/YYYY]	[Time]	[Place]	[Description]	[Names]

Section 4 – Response to Each Allegation / Point

Allegation / Point No.	Admitted / Denied / Partly	Your account and explanation	Supporting evidence
[Number]	[Response]	[Explanation]	[Document / Witness]
[Number]	[Response]	[Explanation]	[Document / Witness]
[Number]	[Response]	[Explanation]	[Document / Witness]

Section 5 – Documents and Witnesses Relied Upon

Documents attached (list with page numbers)
Witnesses you request the committee to examine (name, designation, what they know)

Section 6 – Any Request to the Committee

Requests (e.g., additional time, interim relief, specific evidence to be called)

Declaration

I declare that the contents of this statement are true to the best of my knowledge and belief and that I have not concealed any material fact. I will keep the proceedings confidential and will not contact or influence the other party or any witness in connection with this matter.

[Employee Name]
Signature: ____________
Date: [Date]

Received by
[Member Name], Internal Committee
Date: [Date]

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What this template includes

Statement-type selector (reply, additional statement, rejoinder, final submission)
Chronology table, which helps the committee compare accounts
Point-wise response to each allegation, avoiding vague denials
List of documents and witnesses relied on
Requests to the committee (such as additional witnesses)
Declaration of truth and confidentiality undertaking

When to use it

A respondent replying to the complaint copy shared by the committee
A complainant adding detail to her original complaint before hearings
Either party responding to statements of the other party or witnesses
Submitting a final written submission before the committee concludes

How to customise this template

1Share the form with the complaint copy so the respondent replies within [Number] days
2Number allegations in the complaint so the response table can mirror them
3Allow attachment of extra pages for longer explanations
4Translate the instructions into the employee's language if required
5Log the date of submission in the case checklist

HR tips

Remind both parties not to contact the other party or witnesses about the case
Ask for facts, dates and places rather than opinions about character
Accept the statement even if late; record the delay for the committee to consider
Make sure both parties can see the material the committee relies on

Timelines for replies and the right to respond come from the POSH Act, 2013, its rules and natural justice; verify current provisions before setting deadlines and take legal advice where needed.

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Frequently asked questions

How long does a respondent get to reply to a POSH complaint?+

The rules prescribe a period for the respondent to file a reply after receiving the complaint copy. Check the current rules and state the deadline using [Number] days.

Can the respondent ask for the complainant's evidence?+

Fairness generally requires the respondent to know the case and evidence against them so they can reply. Share what is relied on while protecting confidential information that is not necessary.

Is this statement shared with the other party?+

Usually yes, so that the other party can respond. Tell the employee this upfront in the form instructions.

All 50 posh, workplace safety & compliance →

[Company Logo][Company Name]

STATEMENT OF WITNESS BEFORE THE INTERNAL COMMITTEE

Complaint Ref. No.:: [Reference Number]
Date of Recording:: [DD/MM/YYYY]
Time:: From [Time] to [Time]
Place / Mode:: [Venue / Video Conference]

Witness Details

Name of Witness
Employee ID (if employee)
Designation / Organisation
Department
Witness called by (Complainant / Respondent / Committee)
Relationship with Complainant
Relationship with Respondent
Language of statement

Committee Members Present

Presiding Officer
Member
Member
External Member

Opening Assurance

Form · Word

POSH Witness Statement

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

[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]
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)
Form · Word
POSH Complaint Form
Download .docx
[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 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

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

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

POSH Employee Statement

Preview of the form

Section 1 – Details of the Person Making the Statement

Section 2 – Type of Statement

Section 3 – Chronology of Events

Section 4 – Response to Each Allegation / Point

Section 5 – Documents and Witnesses Relied Upon

Section 6 – Any Request to the Committee

Declaration

What this template includes

When to use it

How to customise this template

HR tips

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Frequently asked questions

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