What condions inuenced the i ncident/accident? (Weather, me of day, etc.). What was the witness’s role in the inciden t/accident sequence? 7. Did the witness no te anything unusu al prior to or duri ng the incident/accident? If yes, please describe what the witness noted and why the witness thinks it was unusual. Please fully describe the work and condi ons in progress leading up to the event. Candidates should be made aware of the existence of the witness. Multiple witness statement forms can be printed for completion by witnesses at the event (those without access to the Cambridge International forms database). Please describe what the witness saw, heard, felt and/or smelled during the incident or accident: 4. This form is an interactive PDF and may be completed in one of two ways: on-screen and then printed out. Describe where the witness was located in relaon to the incident/accident scene. Other persons the witness saw at the scene while the witness was there? 2. Provide your full name and sign your witness statement.N a m e o f W i t n e s s J o b T i t l e / E m p l o y e r A d d r e s s o f E m p l o y e r ( i f o t h e r than BNL) Check if BNL Empl oyee T e l e p h o n e N u m b e r ( s ) E - M a i l A d d r e s s ( e s ) H o m e A d d r e s s Work: Cellular: Home: A c ci d e n t / In ci d e n t D a t e T i m e t h e w i t n e s s a r r i v e d a t the scene Time the witness le the scene 1. Correct errors in spelling or grammar, and other errors you find. Make sure you have written all the relevant facts based on what your recall.
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