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FORM I PROFORMA FOR FILING OF COMPLAINTS OF SEXUAL HARASSMENT
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Janardan Bhagat Shikshan Prasarak Sanstha’s
CHANGU KANA THAKUR
ARTS, COMMERCE & SCIENCE COLLEGE, NEW PANVEL (AUTONOMOUS)
Re-accredited ‘A+’ Grade by NAAC (3rd Cycle-CGPA 3.61)
‘College with Potential for Excellence’ Status Awarded by University Grants Commission
‘Best College Award’ by University of Mumbai
INTERNAL COMPLAINTS COMMITTEE
I. Complainant(s): Student/resident/academic staff/ non-teaching staff/outsider/service provider
Name
Age
Sex
Address
Department/Office
Phone number
E mail
II. Person(s) against whom the complaint is being lodged: Student/academic staff/
non-teaching staff/service provider:
Name
Age
Sex
Address
Department/Office/Class
Phone number
E mail
III. The Complaint:
1.
Is the defendant known to the complainant?
2.
Is this the first incident of this kind? If yes, skip 3and 4.
3.
Were exactly the same person(s) involved? If no,
FORM I PROFORMA FOR FILING OF COMPLAINTS OF SEXUAL HARASSMENT
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Specify further.
4.
Was the first incident reported? To whom?
When? What action, if any was taken?
5.
Approximate date(s), time(s) and location(s) of
incident(s), starting from the most recent.
Additional details of the complaint may be recorded here:
Complaint filed by
Signature:
Date:
Name:
Place:
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