Workplace Accommodation Request

WORKPLACE SAFETY POLICY

Policy No.:

[Reference Number]

Effective Date:

[DD/MM/YYYY]

Version:

[Number]

Owner:

[Safety Officer / Admin Head]

1. Purpose

[Company Name] is committed to providing a safe and healthy workplace and to preventing injuries, ill health and damage to property. This policy sets out the minimum safety standards that apply at all our premises and work activities.

2. Scope

This policy applies to all employees, trainees, contract workers, vendors and visitors at [Work Location] and any other premises, sites or vehicles operated by the company, including client sites where our staff are deployed.

3. Definitions

WORKPLACE SAFETY INCIDENT REPORT

Incident No.:

[Reference Number]

Date of Report:

[Date]

Reported by:

[Employee Name], [Designation]

Part 1 – Incident Details

• Fire / smoke / explosion
• Electrical incident
• Chemical / gas / oil leak or spill
• Equipment, vehicle or machine failure
• Structural failure / falling object
• Injury to person (attach injury report)
• Property damage only
• Other: [Details]

Part 2 – Immediate Action

DISABILITY ACCOMMODATION FORM

Ref. No.:

[Reference Number]

Date:

[DD/MM/YYYY]

Classification:

Confidential

Part 1 – Employee Details

Part 2 – Disclosure (voluntary)

Part 3 – Barriers at Work

WORKPLACE INSPECTION CHECKLIST

Area / Section:

[Department / Line]

Date:

[DD/MM/YYYY]

Shift:

[Shift]

Inspected by:

[Inspector Name]

Mark each item Yes (OK), No (defect – log below) or NA (not applicable).

1. Machinery

2. Electrical

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