Template

Accident Incident and Near Miss Witness Statement

by Colin Johnstone, from the Community

20+

Capture accurate witness accounts for accidents, incidents and near misses. This template records personal details, employer and role, incident location, what was seen or heard, who else was present, actions before and after, reporting details, and confirmation with signatures from the witness and a site representative.

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Generate inspection reports and share them with your team and stakeholders to keep everyone informed.

About author

Community

This community page makes available free workplace checklists and templates created by other users within the SafetyCulture community. SafetyCulture has re-published this content and where possible, has credited the original author. SafetyCulture has not verified the accuracy, reliability or suitability of any community content. You agree that your use of any of this content is in accordance with SafetyCulture’s Terms and Conditions.

Template
Witness Statement Template
Use this witness statement template to document what was seen during an incident. Capture when the statement was taken, who prepared it, the location, the witness name and occupation, and a detailed individual statement, then confirm with a signature. Ideal for construction and field operations, it standardizes evidence collection, supports investigations, and keeps records organized. Use it as is or digitize it in the SafetyCulture app to make reporting faster and easier across your team.
by Dean Crowe, from the Community
Downloads: 10+
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Template
Witness Statement
Use this witness statement template to document what a witness saw, heard, and did during an incident. Capture names, contact details, employment info, time and location, and a signed declaration. Ideal for workplace investigations, site safety, and legal proceedings. Customize for your jurisdiction and attach photos and signatures to support compliance and reporting.
by Seb Lik, from the Community
Downloads: 0
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Template
Accident Incident Near Miss Report Template
Use this incident report template to document accidents, incidents, and near misses on site. Capture personal and witness details, incident type and category, location, task, equipment, and PPE in use. Record a clear description of the event, photos, causal factors, and immediate corrective actions. Log injuries, first aid, emergency response, and return to work information, and note if the event is reportable under RIDDOR. Attach supporting evidence such as inductions, permits, RAMS, training and inspection records, and witness statements.
by Colin Johnstone, from the Community
Downloads: 20+
Get
Template
SMI INCIDENT WITNESS STATEMENT
This incident witness statement form template provides a structured format for documenting workplace incidents and accidents. The form includes essential sections for recording incident details, witness information, safety compliance checks, and detailed observations. It captures crucial information such as the date and time of the incident, location details, witness credentials, and specific observations about safety practices and personal protective equipment usage. The template also includes sections for describing the task being performed, how the incident occurred, and any resulting injuries. Complete with signature fields for both witness and supervisor verification, this form ensures thorough documentation of workplace incidents for safety compliance and record-keeping purposes.
by Mariah Oliveira, from the Community
Downloads: 50+
Get

Witness Statement Template

Use this witness statement template to document what was seen during an incident. Capture when the statement was taken, who prepared it, the location, the witness name and occupation, and a detailed individual statement, then confirm with a signature. Ideal for construction and field operations, it standardizes evidence collection, supports investigations, and keeps records organized. Use it as is or digitize it in the SafetyCulture app to make reporting faster and easier across your team.

by Dean Crowe, from the Community

10+

Get

Template

Witness Statement

Use this witness statement template to document what a witness saw, heard, and did during an incident. Capture names, contact details, employment info, time and location, and a signed declaration. Ideal for workplace investigations, site safety, and legal proceedings. Customize for your jurisdiction and attach photos and signatures to support compliance and reporting.

by Seb Lik, from the Community

Get

Template

Accident Incident Near Miss Report Template

Use this incident report template to document accidents, incidents, and near misses on site. Capture personal and witness details, incident type and category, location, task, equipment, and PPE in use. Record a clear description of the event, photos, causal factors, and immediate corrective actions. Log injuries, first aid, emergency response, and return to work information, and note if the event is reportable under RIDDOR. Attach supporting evidence such as inductions, permits, RAMS, training and inspection records, and witness statements.

by Colin Johnstone, from the Community

20+

Get

Template

SMI INCIDENT WITNESS STATEMENT

This incident witness statement form template provides a structured format for documenting workplace incidents and accidents. The form includes essential sections for recording incident details, witness information, safety compliance checks, and detailed observations. It captures crucial information such as the date and time of the incident, location details, witness credentials, and specific observations about safety practices and personal protective equipment usage. The template also includes sections for describing the task being performed, how the incident occurred, and any resulting injuries. Complete with signature fields for both witness and supervisor verification, this form ensures thorough documentation of workplace incidents for safety compliance and record-keeping purposes.

by Mariah Oliveira, from the Community

50+

Get

Accident Incident and Near Miss Witness Statement

With SafetyCulture you can

Digitize team workflows

Reduce manual errors

Create and share inspection reports

About author

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Accident Incident Near Miss Report Template

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