Witness Statement

Company Letterhead

{{company_name}}

{{company_address}}

Phone: {{phone}}

Email: {{email}}

Website: {{website}}

WITNESS STATEMENT

**Date of Statement:** {{statement_date}}

**Matter/Incident Ref:** {{incident_reference}}

**Employee Subject to Inquiry (if applicable):** {{employee_subject}}

WITNESS DETAILS

**Full Name:** {{witness_full_name}}

**Employee Number (if applicable):** {{witness_employee_number}}

**Job Title/Position:** {{witness_job_title}}

**Department:** {{witness_department}}

**Contact Number:** {{witness_contact_number}}

**Email Address:** {{witness_email_address}}

STATEMENT

I, {{witness_full_name}}, hereby make the following statement concerning the incident/matter that occurred on or about {{date_of_incident}} at approximately {{time_of_incident}} at {{location_of_incident}}.

I understand that this statement may be used in an internal investigation or disciplinary hearing.

I confirm that the information provided below is true and accurate to the best of my knowledge and belief, and I have not omitted any material facts.

DETAILED ACCOUNT OF EVENTS

Please provide a full, chronological account of what you saw, heard, or did in relation to the incident. Include all relevant details such as dates, times, locations, individuals involved, conversations, and any other observations. Be as specific as possible.

{{detailed_account_of_events}}

SUPPORTING EVIDENCE (if any)

Please list any documents, photographs, emails, messages, or other evidence that supports your statement and that you are submitting with this form.

{{supporting_evidence_list}}

DECLARATION

I declare that this statement has been freely and voluntarily made by me. I have read the statement and confirm that it is an accurate record of my evidence. I understand that I may be required to attend a disciplinary hearing or other internal proceedings to provide further clarification on this statement.

SIGNATURE BLOCK

_________________________

{{witness_full_name}}

Witness Signature

_________________________

Date: {{signature_date}}

_________________________

Recorded By (Name): {{recorder_name}}

_________________________

Recorder Signature

_________________________

Date: {{recorder_signature_date}}