Witness Statement

Connection Flooring Ltd

The Future Business Park, Shildon. DL4 2RB
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 *

Accident Incident Other
Person requesting the statement

Andrew Shakesby - Health & Safety Michelle Knowles - HR Other
Name of person giving the statement

First Name Last Name
Department
Please give your version of events
Name of other witnesses

First Name Last Name
Name of other witnesses

First Name Last Name
Name of other witnesses

First Name Last Name
E Signature *

The statement I have given is correct and truthful to the best of my knowledge
Type a question

Clear
Should be Empty:

Connection Flooring Ltd