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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