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HUMAN RESOURCES 550 E. Hospitality Lane Suite 200 San Bernardino, CA 92408 www.sbccd.eduWITNESS REPORT OF INJURY/ILLNESS SECTION I: PERSONAL INFORMATION Witness Name Phone # Home AddressDistrict Employee?

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How to fill out witness report of injury

01

Obtain a copy of the witness report form from the appropriate authority.

02

Provide necessary details like date, time, location of the incident, and details of the injured person.

03

Record the name and contact information of the witness accurately.

04

Document the statement provided by the witness regarding the incident.

05

Have the witness sign and date the report to confirm the accuracy of the information provided.

06

Submit the completed witness report to the relevant party as per the protocol.

Who needs witness report of injury?

01

Employers for workplace injury incidents

02

Insurance companies for claims processing

03

Legal representatives for potential legal proceedings

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What is witness report of injury?

The witness report of injury is a document that provides details of an injury or accident from the perspective of a witness who was present at the time.

Who is required to file witness report of injury?

Any witness who saw the injury or accident occur is required to file a witness report of injury.

How to fill out witness report of injury?

To fill out a witness report of injury, the witness should provide their name, contact information, a description of what they saw, and any other relevant details.

What is the purpose of witness report of injury?

The purpose of a witness report of injury is to provide an objective account of an injury or accident to aid in the investigation and assessment of any legal or insurance claims.

What information must be reported on witness report of injury?

The witness must report their personal information, details of the injury or accident, the names of any other witnesses present, and any other relevant information.

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