Template

Employee and Witness Statement Form

by Josh McComas, from the Community

10+

Use this employee and witness statement form to document workplace incidents clearly and consistently. Capture essential information including the employee or witness name, date and time, phone number, signature, and a detailed narrative of what occurred. This template supports thorough investigations, helps preserve accurate accounts, and promotes safety and compliance across job sites and workplaces. Adapt the fields to suit your procedures and store completed statements alongside other incident records for easy reference.

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

With SafetyCulture you can

Digitize any process, procedure or policy

Eliminate mistakes made by paper-based processes

Create and share professional reports instantly

Confirm accountability and compliance with a digital log

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
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
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+
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
Downloads: 0
Get
Template
Initial Employee Incident Report
This employee incident report form template provides a structured format for documenting workplace incidents and injuries. The form captures essential information including employee details, incident timing, location specifics, injury description, and witness accounts. It includes fields for recording when supervisors and safety personnel were notified, medical treatment details, and comprehensive incident descriptions. This template helps organizations maintain accurate records of workplace incidents, ensure proper reporting procedures, and track safety compliance. Designed for HR professionals and safety managers, this form supports thorough documentation of workplace incidents while maintaining clear communication channels between employees, supervisors, and safety personnel.
by Harry Miles, from the Community
Downloads: 70+
Get

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

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

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

Initial Employee Incident Report

This employee incident report form template provides a structured format for documenting workplace incidents and injuries. The form captures essential information including employee details, incident timing, location specifics, injury description, and witness accounts. It includes fields for recording when supervisors and safety personnel were notified, medical treatment details, and comprehensive incident descriptions. This template helps organizations maintain accurate records of workplace incidents, ensure proper reporting procedures, and track safety compliance. Designed for HR professionals and safety managers, this form supports thorough documentation of workplace incidents while maintaining clear communication channels between employees, supervisors, and safety personnel.

by Harry Miles, from the Community

70+

Get

Employee and Witness Statement Form

About author

You might also like

SMI INCIDENT WITNESS STATEMENT

Witness Statement Template

Witness Statement

Initial Employee Incident Report

You might also like

SMI INCIDENT WITNESS STATEMENT

Witness Statement Template

Witness Statement

Initial Employee Incident Report