Workplace Sexual Harassment Complaint Statement
Category: Workplace Rights and Safety
Updated:
Confidential Word drafting aid for a workplace sexual harassment complaint, setting out incidents, witnesses, supporting material and assistance requested.
Workplace Sexual Harassment Complaint Statement For an aggrieved woman preparing a complaint to the appropriate Internal Committee or Local Committee under the POSH Act. Choose the correct authority and seek assistance if needed. Date: [date] To The Presiding Officer or Chairperson [Appropriate Internal Committee or Local Committee] Complainant name and safe contact: [enter details] Workplace or connection with the workplace: [enter details] Respondent details known to the complainant: [enter details] Incident dates or last incident in a series: [enter details] Sir or Madam I submit this complaint concerning the incidents set out below and request the Committee to deal with it under the applicable procedure. I request confidential handling and communication through the safe contact identified above. The statement separates each incident and the available supporting material. 1.
Incident account: [describe the conduct, date, location and persons present]. 2. Witnesses or persons with relevant information: [identify their connection to the events]. 3. Supporting material: [identify messages, records or other evidence]. 4. Assistance or interim measures requested: [state what is needed and why]. 5. If relevant, explanation for filing outside the ordinary period: [state actual circumstances]. Enclosures Relevant messages or records, preserving originals Incident chronology and witness list Earlier complaint or correspondence, if any Signature: ____________________ Name: [name] Place: [place] How to use this template This page is guidance for the person preparing the document. Remove it from the submission copy after adapting the draft. Do not send unfilled placeholders or invented facts.
Check the correct Committee, including the Local Committee route where applicable. A general HR email is not always the statutory complaint channel. The ordinary statutory period is three months from the incident or last incident in a series. A further extension may be available on recorded grounds; it is not automatic. The Committee must provide reasonable assistance for reducing a complaint to writing where the aggrieved woman cannot do so. Keep the complaint and evidence confidential. Do not circulate names or allegations publicly. Ask the Committee about safe submission and protection needs. This is an original LawSphereX editable aid based on the references below. It is not a government-issued form, certification, legal opinion or promise that a request will be accepted. Where an authority prescribes a form, use that current form.
Official references Government of India POSH workplace procedures https://www. istm. gov. in/home/posh_act Bureau of Indian Standards official SHe Box guidance https://www. bis. gov. in/176425-2/? lang=en Sources checked on 6 November 2026. Recheck the current authority requirements before submission or reliance.