Title Page
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Site conducted
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Business unit
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Conducted on
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Prepared by
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Document No.
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Location
Witness Statement.
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1. This statement should be completed by the witness as soon as possible following the accident/incident.
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2.The witness should restrict their statement to facts and not include assumptions.
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3. If the witness only saw some of the events leading to the accident, this should be stated.
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Incident Ref No. (Obtained from incident database)!
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Location of Accident/Incident
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Date/Time of Accident/Incident.
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Please describe the accident/incident which you witnessed:
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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.
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Witness Name
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Signature
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Date of signature
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Completed forms should be attached to the incident record on the incident database. Electronic copies of this statement will be available to the QSHE Department through the app. GDPR protocols must be followed at all times when dealing with accident/incident investigations including witness statements. Any queries, contact QSHE.UK@dbschenker.com
