Free Workplace Witness Statement Form Template

Workplace Witness Statement Form

Please complete this form to provide your account as a witness to a workplace incident at [Your Company Name]. Your detailed and accurate testimony is crucial for a thorough investigation and resolution of the incident.

Witness Information
Full Name:		[Name]
Phone:
Email:
Job Title and Department:
Date and Time of Statement:

Incident Details
Date and Time of Incident:		[Date], [Time]
Location of Incident:
Brief Description of Incident:

Witness Account
Detailed Description:		I entered the break room and saw colleagues [Name] and [Name] in a heated argument. Voices were raised, and the argument was about project allocations.
Sequence of Events:
Other Witnesses:

Additional Information
Injuries or Damages Observed:	No physical injuries were observed. A coffee cup was knocked over and broken during the argument.
Assistance Provided:
Other Relevant Information:

Acknowledgement:

I, [Name], declare that the information provided here is true to the best of my knowledge and belief. I understand my right to review and amend this statement if necessary.

[Name]

[Job Title]

[Month Day, Year]

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