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Witness Statement Template – Florida
Use this template to document what you witnessed while keeping exhibits and retention details organized for follow-up.
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Witness Statement Template
This Witness Statement is made on [Date] by:
Full Name of Witness: [First Name Last Name]
Address: [Full Address]
Phone/Email: [Contact Information]
Occupation: [Job Title or N/A]
Relationship to Case/Parties: [Relationship or N/A]
1. Witness Identification
Witness Name: [Witness Name]
Preferred Contact Method: [Phone/Email]
Language (if applicable): [Language or N/A]
2. Event Details
Date of Incident: [MM/DD/YYYY]
Time: [Time or Approximate Time]
Location: [Address or description of location]
People Involved: [Names if known/descriptions]
3. Supporting Evidence
Exhibit A: [Photographs/Video files and identifiers]
Exhibit B: [Report/record/other]
Exhibit C: [Additional document/other]
Additional Exhibits: [List or N/A]
4. Statement of Facts (Chronological)
[Chronological description of what I witnessed, including what I saw, heard, and did, as applicable]
5. Statement Purpose and Reference
Case/Incident Reference: [Case name/claim #/internal file #/other]
Statement Requested By: [Name/Organization/Department]
Delivery Method: [Email/Portal/In-person/Other]
6. Declaration of Truth and Signatures
I, [Witness Name], declare that the facts stated in this witness statement are true to the best of my knowledge and belief.
I understand that making a false statement may result in penalties under applicable perjury laws.
Witness Signature: _______________________ Date: ___________
Printed Name: ___________________________
Notary Acknowledgment (optional): __________________________
Notary Name/Commission: _________________________________
Date: ______________________________
7. Evidence Checklist (Module)
Complete the evidence checklist:
Item Type | ID/File Name | Source | Location/Link | Retention Until |
[Photo/Video] | [File name/ID] | [Name/Camera/CCTV] | [Link/Path] | [Date/N/A] |
[Report/Record] | [Identifier] | [Agency/Company] | [Link/Path] | [Date/N/A] |
[Other] | [Identifier] | [Source] | [Link/Path] | [Date/N/A] |
8. Claim/Insurance Intake (Module)
Insurer/Carrier: [Name or N/A]
Policy/Account Number: [Number or N/A]
Claim Number: [Number or N/A]
Adjuster/Contact: [Name/Phone/Email or N/A]
Reported Date: [MM/DD/YYYY or N/A]
9. Environment and Conditions (Module)
Weather: [Clear/Rain/Snow/Wind/Other/Unknown]
Lighting: [Daylight/Artificial/Dark/Other/Unknown]
Noise/Crowd Level: [Low/Medium/High/Unknown]
Surface/Area Condition: [Dry/Wet/Icy/Uneven/Crowded/Other/Unknown]
Odors/Contaminants Noted (if any): [Description or N/A]
10. Evidence Preservation (Module)
Device Used to Capture Media (if any): [Phone/camera/other/none]
Original File Location: [Device/cloud/folder path/other]
Sharing Permissions: [Restricted/public/unknown]
Retention Until (if known): [Date or N/A]
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Easy-to-understand jargon
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Details
Learn more about
Witness Statement Template – Florida
Click below for detailed info on the template.
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.
Florida Witness Statement Template FAQ
Why does this template place the exhibits section before the narrative?
Some reviewers prefer to see what documentation exists before reading the narrative, especially when there are photos, videos, or reports that anchor timing and location. Listing exhibits early makes it easier to reference them while writing the chronology, and it helps the receiving party confirm that attachments are complete. This order can also reduce follow-up requests because the recipient can quickly identify missing items. The narrative still remains the core account, but the exhibit list becomes a roadmap for verification.
How should a witness write a chronological statement without adding opinions?
A practical approach is to describe what happened in the order you perceived it, focusing on observable actions, movements, and statements. If you are uncertain about a time or sequence, label it as approximate instead of forcing precision. Avoid phrases that assign blame or intent unless you directly observed something that supports that conclusion. If you have a reaction or interpretation, keep it separate from the factual description. The goal is a clear account that another person could understand without needing additional explanation.
What should be included in the evidence checklist module?
The checklist should identify each item in a way that makes it easy to locate and preserve. For media, include file names, camera sources, and a link or storage path. For documents, include report numbers, dates, and the issuing organization. The “Retention Until” field is helpful when footage or logs might be overwritten. A complete checklist reduces the risk that evidence is misplaced and makes it easier to confirm that the record you reviewed is the same record being relied upon later.
When is it helpful to add claim or insurance details to a witness statement?
Claim fields are helpful when the statement is being collected as part of an insurance process or when an organization is tracking multiple incidents under different identifiers. Including the carrier, claim number, and adjuster contact can reduce routing errors and speed requests for additional information. Even if the matter is not purely an insurance claim, the module can function as a case handler directory. The key is to include only what you know and to use “N/A” or “Unknown” when details are not available.
How do environment and conditions details affect the usefulness of the statement?
Conditions like lighting, surface wetness, crowd level, and visibility can influence what a witness could realistically perceive. Recording these factors supports the credibility of the account and helps investigators understand why details may be clear or uncertain. It also helps reconcile differences between statements, such as one witness reporting a slip hazard while another did not notice it. Keeping conditions tied to what you observed — rather than what you assume — makes the information more reliable.
Should the statement be notarized?
Notarization may be requested in some contexts, but it is not always necessary. The template includes an optional notary block so the statement can be executed in the form requested without changing the rest of the document. If notarization is not required, you can leave that section blank and rely on the declaration and signature. If you are unsure what format is preferred, you can ask the requesting party before finalizing, because different organizations have different intake practices.
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