Get Workers Comp Witness Statement Form

Completing the Workers Comp Witness Statement Form online is an essential process for providing accurate information related to a workplace incident. This guide will walk you through each section of the form to ensure you can fill it out correctly and efficiently.

Follow the steps to complete the form accurately.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. In the 'Injured Worker' section, enter the name of the injured worker as it appears on official documents. Make sure the spelling is accurate.
3. Move to the 'Witness Details' section. Here, enter your name and date of birth in the specified fields. Complete your address and phone number to enable the authorities to reach you if necessary.
4. Fill in the employer's name and your occupation to provide context about your relationship with the injured worker.
5. Indicate your relationship to the injured worker by selecting one of the options provided: Co-worker, Family, or Other. If you choose 'Other,' please specify your relationship.
6. In the 'Incident Details' section, record the date and time of the incident. Ensure that you use the correct format.
7. Provide the place where the incident occurred, along with the type and location of the injury. Be as specific as possible.
8. If you were an eyewitness to the incident, select 'Yes' and provide a detailed description of what you witnessed. If not, select 'No' and explain how you became aware of the incident.
9. In the 'Declaration' section, read the statement carefully. By signing, you affirm that the information provided is true and correct.
10. Finally, complete the form by adding your signature and the date. After ensuring all information is accurately filled out, save your changes. You can then download, print, or share the completed form as necessary.

Complete your documents online today to ensure a smooth process.