Affidavit Number: [Affidavit Number]

Date: [Date]

I, [Affiant’s Full Name], being duly sworn, do hereby declare and affirm the following:

1. Identity and Affiliation:

I am a [Title/Position] employed by [Your Company Name], located at [Your Company Address]. I have been involved in interior design for [Number of Years] years and am directly involved in the incident outlined herein.

2. Description of the Incident:

On [Date], at approximately [Time], the following incident occurred at [Location/Address]:

During the installation of a custom shelving unit, one of the shelves was improperly secured and detached from the wall. The shelf fell, causing several decorative items valued at over $5000 to shatter. This incident occurred despite prior assurances from the installation team that all fixtures had been securely mounted. This incident occurred during the course of my duties while executing an interior design project managed by [Your Company Name].

3. Immediate Actions Taken:

Following the incident, I took the following actions:

• I immediately cleared the area to ensure the safety of all personnel and visitors in the vicinity.

• I documented the scene with photographs and notes detailing the damage and the setup prior to the incident.

• I contacted the installation company to report the issue and requested their immediate presence to assess and rectify the error.

• I informed the client of the incident, outlining the steps being taken to address the damage and prevent future occurrences.

• A meeting was scheduled with our internal safety team to review our installation protocols to enhance our quality assurance procedures.

4. Witnesses:

The following individuals were present at the time of the incident and can act as witnesses:

• [Name 1, Contact Information]

• [Name 2, Contact Information]

5. Photographic Evidence:

Photographs and/or video documentation of the scene post-incident have been taken and are attached herewith as part of this affidavit.

6. Further Steps:

I am aware that further investigation may be required and I am prepared to cooperate fully with any investigations or legal procedures that may follow. I am also committed to implementing corrective measures suggested by [Your Company Name] to prevent future occurrences.

7. Statement of Truth:

I affirm that the information provided in this affidavit is true and accurate to the best of my knowledge and belief. I understand that providing false information in this affidavit can lead to penalties under the law.

Affiant’s Signature:

[Date]

Subscribed and sworn to before me this [Day] day of [Month], [Year].

Notary Public:

[Seal of Notary Public]

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