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Employee Witness Statement Template
Record workplace incidents with a clear, factual witness account using this Employee Witness Statement Template.
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Employee Witness Statement Template
Statement Date: [Date]
1. Employee (Witness) Information
1.1 Full Name: [First Name Last Name]
1.2 Job Title/Department: [Title/Department]
1.3 Work Location: [Office/site]
1.4 Phone/Email: [Contact info]
1.5 Supervisor (Optional): [Name]
2. Incident Information
2.1 Date of Incident: [MM/DD/YYYY]
2.2 Time of Incident: [Time]
2.3 Location: [Specific location]
2.4 Type of Incident: ☐ Safety ☐ Harassment ☐ Misconduct ☐ Theft ☐ Discrimination ☐ Other: [Type]
2.5 People Involved: [Names and roles, if known]
2.6 Other Witnesses (If Known): [Names]
3. What I Observed (Facts Only)
3.1 Where I Was and What I Was Doing. [Describe your position and activity before the incident.]
3.2 What I Saw and Heard. [Chronological description. Include exact words if you remember.]
3.3 What Happened Next. [Steps that followed, actions taken, who responded.]
3.4 Injuries or Property Damage (If Any). [Describe what you observed.]
3.5 Security Cameras / Evidence (If Known). [Camera locations, photos, messages, etc.]
4. Actions I Took
4.1 Immediate Actions. [Who you told, reports made, assistance provided.]
4.2 Reports/Notifications. I reported this to: [HR/Manager/Security] on [Date/time].
5. Attachments (Optional)
5.1 Attached items (if any):
Exhibit A: [Photo/video]
Exhibit B: [Email/text message]
Exhibit C: [Other]
6. Confidentiality and Accuracy
6.1 I understand this statement may be used for an internal investigation and may be shared with those who need to review it.
6.2 I have written the above to the best of my knowledge and based on what I personally observed.
Signatures
Employee/Witness: [Full Name]
Date: [Date]
Signature: ___________________________
Notary / Notarization (Optional)
Subscribed and sworn (or affirmed) before me on [Date], by [Employee/Witness Name], who is personally known to me or has produced identification.
Notary Public Signature: _______________________
My Commission Expires: _______________________
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Employee Witness Statement Template
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For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
EMPLOYEE WITNESS STATEMENT TEMPLATE FAQ
What is an employee witness statement?
An Employee Witness Statement is a written account from an employee describing what they personally saw, heard, or experienced during a workplace incident. It is often used for internal investigations, HR processes, safety reports, or legal claims. The goal is to capture facts in a clear, chronological format.
What should be included in a workplace witness statement?
Include: the incident date/time/location, people involved, what you personally observed (not rumors), exact words if remembered, actions taken, and any supporting evidence. Keep the statement factual and avoid speculation.
Should an employee witness statement be notarized?
Usually no for internal HR investigations, but it can be requested in some legal contexts. This template includes an optional declaration section and an optional notarization section only if needed.
Can you include opinions in a witness statement?
It’s best to focus on facts. If you include opinions, clearly label them as your impression and explain what observations caused that impression. This template is structured to prioritize objective facts.
Who can see the statement?
Typically HR, management, and investigators may review it, and it may be shared with legal counsel or a government agency if the matter escalates. This template includes a confidentiality reminder, but actual confidentiality depends on law and company policy.
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