Information
-
Witness Name
-
Date and Time
-
Prepared by
-
Location
Witness Statement
-
Witness Name
-
Witness Age
-
Witness Phone Number
-
Witness Employer
-
I saw the incident.
-
To the best of my knowledge the incident occurred in the following manner:
-
I did not see the incident.
-
Information that was given to me indicates the incident occurs as followed:
-
I have no knowledge of the incident.
-
Additional Comments/Pertinent Information
-
Witness Signature
-
Date & Time
