Witness Statement

Connection Flooring Ltd

Henson Close, South Church Enterprise Park, DL14 6WA
Witness Statement Form

If you are requested to complete a witness statement form then please do so asap and certainly within 24 hours giving as much detail as possible. The details given will be used and stored with the heighest level of confidentiality. Failure to comply with the statement request and time period may lead to disciplinary action.
Statement regarding*

AccidentIncidentOther
Person requesting the statement*

Andrew Shakesby - Health & SafetyMichelle Knowles - HROther
If other please put name here

First NameLast Name
Name of person giving the statement*

First NameLast Name
Department*
Please give your version of events
Name of other witnesses

First NameLast Name
Name of other witnesses

First NameLast Name
Name of other witnesses

First NameLast Name
E Signature*

The statement I have given is correct and truthful to the best of my knowledge
Your Signature

Clear
Should be Empty: