Workplace Witness Statement Form
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.
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Witness Information |
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Full Name: |
[Name] |
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Phone: |
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Email: |
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Job Title and Department: |
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Date and Time of Statement: |
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Incident Details |
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Date and Time of Incident: |
[Date], [Time] |
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Location of Incident: |
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Brief Description of Incident: |
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Witness Account |
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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. |
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Sequence of Events: |
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Other Witnesses: |
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Additional Information |
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Injuries or Damages Observed: |
No physical injuries were observed. A coffee cup was knocked over and broken during the argument. |
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Assistance Provided: |
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Other Relevant Information: |
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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]
