Witness Incident Report Form

Information you will need

• What time of day did the incident occur?
• Was anyone injured?
• Were the police notified?
• Was a police report filed?
• Was medical treatment provided?
• Who’s filing the report?
• What’s their title?
• What’s the date of the incident?
• At what time did the incident occur?
• Where did the incident occur?
• What happened?
• What injuries were sustained? (if applicable)
• Was medical treatment provided at a hospital?
• Where was medical treatment provided?
• Where did medical treatment take place?
• Who received this report?
• What action was taken?
• Was medical treatment provided on site?
• What’s the witness's address?
• What’s the witness's phone number?
• What’s the witness's email?
• What were the conditions?
• Was there property damage?
• What was the damage? (if applicable)

…and 11 more fields in the PDF.

The form includes 2 signature lines, a witness section.