Internal Complaint Form

Employee No / Student Register No:

Designation:

Department / Shift:

Date of Incident:

Time of Incident:

Perosn(s) you allege committed the sexual Harassment : Name

Shasun Employee Vendor Outsider

Please describe the incident in detail, including your reaction to the incident:

Person(s) who witnessed the incident, if any:

I confirm that the information given in this form is true, complete and accurate, and I have stated the facts to best of my ability and knowledge.

Employee Signature:

Date