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POSH Witness Statement

The POSH witness statement is the form the Internal Committee uses to record what a witness saw, heard or knows about the incident under inquiry. It captures question-and-answer evidence in the witness's own words, is read back, and is signed by the witness and committee members.

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[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

The witness was informed of the purpose of the inquiry, that the proceedings are confidential, that retaliation for giving evidence is prohibited, and that the statement will be read back before signing.

Questions and Answers

No.	Question (asked by)	Answer of Witness
1	Please describe what you saw or heard on [DD/MM/YYYY]. (Committee)	[Answer]
2	Where were you and who else was present? (Committee)	[Answer]
3	[Question] (on behalf of Complainant)	[Answer]
4	[Question] (on behalf of Respondent)	[Answer]
5	Is there anything else you would like to tell the committee? (Committee)	[Answer]

Documents Produced by Witness

Document 1 (description, date)
Document 2 (description, date)

Declaration of Witness

I have read / have had read to me the above statement in a language I understand. It is a true and correct record of what I told the committee. I gave this statement voluntarily. I undertake to keep the inquiry and my statement confidential and not to discuss it with any party or colleague.

Witness
[Witness Name]
Signature: ____________
Date: [Date]

Recorded before
[Presiding Officer Name]
Presiding Officer

[Member Name]
Member

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What this template includes

Witness identity and relationship to both parties, to judge independence
Name of the party who called the witness
Question-and-answer table preserving exact wording
Space for questions put on behalf of the other party
Documents produced by the witness
Read-back confirmation and signature
Confidentiality and non-retaliation undertaking

When to use it

Recording a colleague who was present during an alleged incident
Recording someone the complainant confided in soon after the incident
Taking evidence from a security guard, cab driver or vendor staff
Recording a witness named by the respondent in their defence

How to customise this template

1Add more rows to the Q&A table as needed during the session
2Record answers verbatim as far as possible, in the language spoken, with translation if needed
3Note start and end time of the session
4Number each page and have the witness initial every page
5File the signed copy as an annexure to the inquiry report

HR tips

Ask open questions first ('What did you see?') before specific ones
Do not tell the witness what others have said
Record a witness's refusal to answer a question, with reason
Reassure the witness about protection from retaliation at the start

Witness evidence must be taken in line with the POSH Act, 2013, its rules and principles of natural justice; verify current procedure and take legal advice for disputed cases.

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Frequently asked questions

Can a witness refuse to appear before the POSH committee?+

Employees are generally expected to cooperate with an internal inquiry under company policy, and the committee has certain powers under the Act. Non-employees may participate voluntarily; record any refusal.

Should the respondent be present when a witness is examined?+

Practices vary; many committees examine witnesses separately and share the statement with the parties for response. Follow your policy and ensure both parties can respond.

Does the witness get a copy of their statement?+

The witness signs the statement after it is read back. Whether a copy is given depends on your policy; confidentiality requirements apply either way.

All 50 posh, workplace safety & compliance →

[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
Form · Word
POSH Employee 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

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

[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