Template: Witness Statement Report

What is a Witness Statement Report?

A Witness Statement Report is a document in which events are recorded by someone who saw/heard/felt it occur. The document is signed by the witness to confirm that its contents are true.

What is the purpose of a Witness Statement Report?

The purpose of a Witness Statement Report is to record all statements of those who witnessed an event. This document can be used as written evidence of the event.

Why do I need a Witness Statement Report?

A Witness Statement Report may be required in the event of:

• An injury: as a way to rectify any workplace hazard(s)
• Court: as evidence of a particular series of events
• Insurance purposes

How do I complete a Witness Statement Report?

To complete a Witness Statement Report, a witness to an event must:

• Voluntarily complete the form
• Indicate the date of completion of form
• Indicate the date of event(s)
• Record the details of the event (include what was seen, heard, smelled, and felt, if relevant)
• Sign the form to confirm that to his/her knowledge the statements recorded in the document are true

How do I use a Witness Statement Report?

In the event of an incident:

1. Provide immediate assistance.
2. Once any injured employee has been appropriately taken care of, a supervisor should inquire as to whether there were any witnesses to the event.
3. Allow the witness to complete the form independently, if desired.
4. If the witness would prefer to be interviewed, ensure that all details of the conversation are recorded.
5. Once the form is completed, the witness will need to sign the form indicating that its contents are true.
6. Make appropriate changes to eliminate worksite risks, if applicable.
7. Provide the statement to the appropriate authorities, if required.

The following downloads are available for use:

Witness Statement Report Companion
Witness Statement Report

The following provides a listing of sample templates, documents, articles and other resources to help you in carrying out your duties and managing your worksite. It is expected that the documents will be amended to suit the styles, needs and circumstances of the individual, or company, involved. These resources are not intended to replace an individual’s, or a company’s, professional and skillful judgement. Each template, document and article and other resource should be assessed within the context of the individual’s, or company’s own day-to-day operation. Individuals and companies must exercise proper judgment respecting the correctness and applicability of the material. Hard Hat Hunter accepts no responsibility for any errors or omissions, and expressly disclaims any such responsibility.