15 Employee Witness Statement Forms

Whenever there are accidents in the workplace, employees who have witnessed the incident must report and inform the business management immediately without any delay. This is to assure that any medical need for the victim of the accident will be catered by the professional physicians and that the issue will be resolved. Specifically, an employee witness statement form will be the legal document that the witnessing employees must use for indicating their stories and the sequence of events that led to the incident’s occurrence.

Blank Witness Statement Form

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Size: 23 KB

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Worker Compensation Witness Statement

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  • PDF

Size: 85 KB

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Claim Initiation Witness Statement Form

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  • PDF

Size: 218 KB

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What Is an Employee Witness Statement Form?

An employee witness statement form is a document that is provided for employees whenever there is a need for gathering reports regarding an accident or any incident that happened on the premises of the workplace. The form’s layout will mainly center on the general information of the witness and the details of the accident.

With this document, the authorities will be able to collect the essential details and file it together with other supporting documents that can be used for acquiring a resolution for the case. In addition, the company management wherein the incident occurred will also benefit from the statement form by promoting open communication from the employees involved and helping in determining who will be mandated to undergo a disciplinary action or termination.

College Employee Witness Statement

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Size: 182 KB

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Witness Statement Form Template

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Size: 30 KB

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Incident Accident Witness Statement Form

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  • PDF

Size: 91 KB

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What’s Inside an Employee Witness Statement Form?

Employee witness statement forms have simple outlines and formats as it will center on the details and description of the incident report that the employee witnessed. Below are some of the sections that should be present on the form to assure that enough data will be collected for the case:

Witness Information

This will have the name of the witness, his job position in the company, as well as his work schedule or the number of service hours that he is required to comply regularly. The employee’s identification and social security numbers may also be stated in this section depending on the type of case or incident to be reported. Other details of the witness include his contact number at work and at home to allow the authority in calling the witness for further clarification of his statements and claims.

Incident Summary

This contains the date and the place of the incident that was witnessed by the employee. How the employee knew about the incident will also be indicated along with a few questions to be answered that are associated with the incident. On the other hand, a questionnaire form can also be separately provided for the employee or the witnessed in order to gather in-depth details and include subjects that will be used for the process of investigation.

Statement Description

This is a blank section that must have enough space for laying out the detailed statements of the witness about the incident. The sequence of the events should be properly lined by the witness statement to avoid confusion in the authorities. Along with the sequence is the specified activity that led to the discovery of the witness, the lists of objects, and names of people who are in the location who contributed to the whole incident.

List of Enclosed Documents

This will indicate the specific legal forms, images, and other printed proofs to serve as pieces of evidence for the case. The witness must only present the documents that are his own property or those that he was able to legally obtain from authorized personnel.

Confirmation and Signature

After completing the entries on the form, the witness will have to affix his signature verification on this section to certify that he confirms the facts and statements that he disclosed. Along with his signature is the date when he completed the document and submitted the form with the associated enclosed evidence to the authority and the company.

General Witness Statement Form

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Size: 1 MB

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Injury Witness Statement Form

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  • PDF

Size: 78 KB

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Witness Interview Statement Form

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  • PDF

Size: 484 KB

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Examples of Employee Witness Statement Forms

There are a lot of examples of employee witness statement forms and these are some of the following:

  • Disciplinary Investigation Witness Statement Form – Those employees who were reported due to an inappropriate behavior resulting in an accident will need a witness to complete this form. The statements of the witnesses will be used for distinguishing the type of employee disciplinary action that is to be required for the employee.
  • Incident Accident Witness Statement Form – The type of injury that the employee acquired and how it may be prevented in the future will be stated in this form. The witness, however, must state the specific events that he saw along with the details of how he observes the intensity of the injury that the employee got due to the accident. An acknowledgment statement is also found on the form which will indicate the amount that the company will provide for the medical reimbursements and financial aid for the victim.
  • Worker Compensation Witness Statement Form – Some countries have a worker’s compensation law that allows workers to receive a specific amount in events of injuries and accidents in exchange for ceasing their rights in suing the company for the incident. Although not every country observes this law, employee suggestions are always affected regardless of the injury level especially if these are due to the faulty materials and tools in the company.
  • Nonetheless, with a worker compensation witness statement form, an employee will be able to state the details of the incident and aid in informing the company appraisal about his intention of obtaining the insurance in the compensation package. The company will then determine and categorize the particular level of insurance amount that they will provide for the employee depending on the medical needs for curing and addressing the employee’s requests. Documents such as the employee’s medical forms and examination results must be also enclosed with this document.

Injured Employee Witness Statement Form

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Size: 156 KB

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Worker Witness Statement Form

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Size: 15 KB

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Disciplinary Investigation Witness Statement

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  • DOC

Size: 33 KB

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Tips for Completing an Employee Witness Statement Form

When an individual witnesses an incident, two things are the main choices that he can consider, which can either be reporting the incident to the authority or be keeping a shut mouth to avoid conflict. However, avoiding the conflict will not contribute to the resolution of the case and to promoting justice for the victims, which why it is essential that regardless of the fear, witness statement should state facts and stand with what they saw and what they know. Nonetheless, below are some of the tips for any employee who will be the witness to a particular incident:

Focus on facts

A witness is a person who has seen what happened during the incident. By presenting factual data on the statement form, the employee will not only contribute to the evidence but also in lessening the length of the company to complete the investigation process. Due to the data that the witness stated on the form, the investigators and the management evaluation will know where they must begin their search and data gathering procedures. Additionally, the facts stated must be supported by the presentation of the documents that the witness have attached unto the form, which will also be served for the investigation.

Layout the dates and time

A witness statement must be in all the details that the witness or the employee was able to remember. The details can include the number of minutes or hours after each sequence of the incident. With this, the investigators and the authority will be able to conduct an effective record review through their attendance sheets and even the videos that the CCTV of the company acquired during the day of the incident.

Review the statements

Before submitting the finished statement form, assure that every field on the document has been filled out with answers and explanations. In the event that a field does not associate with the incident, it is significant to indicate an “N/A” or “not applicable” to symbolize that the field is not related to pursuing a resolution.

Complete and file the form immediately

Causing a long pause to a case will only indicate that the supplied evidence was not enough to hold the solution, which is why it is essential that any witness must file their personal statements after completing the whole form. This will imply the strong stand of the witness to remain at what he knows and that his statements were not moved due to outside forces such as company politics and even bribery. Another benefit of filing the completed form immediately is that it will allow the investigators to begin the process of gathering ideas without wasting too much time on waiting for the unfinished statements.

Printable Witness Statement Form

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Size: 4 KB

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Accident Witness Statement in DOC

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  • DOC

Size: 6 KB

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Incident Report Witness Statement

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  • DOC

Size: 71 KB

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Employee witness statements are significant to solving any issue in a business company wherein employees are involved and held accountable for a specific action. Incidents that demand the usage of this form include dealing with workplace complaints that relate to sexual harassment and even mandating cultural diversity and bullying. Along with the aforementioned situations are other issues that are evident in any workplace that was not ruled by proper regulations and professional managers. However, regardless of the type of industry and kind of jobs in a company, it is always a protocol to allow employees speak what they have witnessed to promote equality and understanding in the workplace.

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