Forms Witness statement

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SPHS014B

Witness statement

Complete this form as soon as possible after the incident.
Restrict your statement to facts.
State clearly if you saw only part of the events.

Fields marked required are required.

1. Your details

Witness name *

Job title

Email address

Phone number

Address

Company

2. Incident details

Date and time of incident *

Enter the date and time in your current timezone.

Location of incident *

3. Statement

Please describe the incident which you witnessed *

Include facts only. Maximum 20,000 characters.

Upload relevant documents or photos

4. Declaration and signature

I hereby declare that the information given is full and true to the best of my knowledge. I understand that if, at a later date, it is discovered that I have knowingly misrepresented the facts, disciplinary action may be taken against me, which may include dismissal.

Signature (type your full name)

Statement date and time

Enter the date and time in your current timezone.

I confirm that this statement is full and true. *

Check that your statement is accurate before submitting. Your statement will be kept on file for at least three years.