Incident Witness

Statement

Please state your account below clearly, honestly, as fully as possible and to the best of your recollection. The purpose of investigation is to gather facts and pertinent information. This statement may provide important details related to the incident.

Instructions on how to complete this form:

  1. Give your account of what you heard or saw during the incident.
  2. Keep events in chronological order.
  3. Be as specific as possible (when, where, what time, how, who, what, etc.)
  4. Provide first and last names of people when possible.
  5. If you need to provide more information, additional documents may be attached.
I affirm that this statement is true and accurate to the best of my knowledge, recollection and understanding. I understand that I may be asked to answer further questions in person. I also understand that my statements are confidential and may only be shared with Clark Construction Company management and may be shared with any state departments, agencies or any other law-enforcement agency having the authority to investigate the incident.