Witness Statement Form
Editable Word witness statement form for Queensland workplaces: witness and incident details, a sketch, what they saw and heard in their own words, a declaration, interview record and tips for taking a statement.
RG
Written by Ryan Graham, health and safety professional (16 years on Queensland sites)
$9.99 incl. GST
AUD · one-off purchase · instant download
- Instant download · your links arrive by email straight after checkout and work for 3 months, so save your copy
- Make it yours in minutes · edit in Microsoft Word and add your logo
- Quality guarantee · we'll fix any problem, then refund you or give store credit if you're still not happy
- Secure checkout · card, Apple Pay or Google Pay through Stripe
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About this template
A two page form to record what one witness saw or heard about an incident, in their own words. It keeps what the witness saw apart from what others told them, records who took the statement, and says plainly that it is a workplace record that an inspector may ask to see.
What Is Included In Our Witness Statement Form?
- Incident and witness details, with a work contact only
- Where the witness was, with a sketch box
- What they saw and heard in order, in their own words
- Conditions, what they did and who else saw it
- What others told them, kept separate
- A declaration and signature in statement-of-truth style
- An interview record with read-back and changes initialled
- Good practice tips for taking a statement
Legislation and Codes of Practice Referenced
- Work Health and Safety Act 2011 (Qld): ss 38, 155 and 171
- Privacy Act 1988 (Cth): ss 6D and 7B
What You Get
- An editable Microsoft Word form (2 pages), A4 portrait, to fill in on screen or print
- Tick boxes and date pickers that work in Word
- Business details typed once and filled in on every page, plus a space for your logo
- Sign-off and document control
Review it and adjust it to suit your business, your sites and the way your team works, and talk it through with your workers. If you have any trouble downloading this template, you can contact us at any time. Please make sure you read our Disclaimer before downloading.
Having trouble with your download? Contact us any time. Please read our Disclaimer before downloading.
How to use it
From download to site in three steps
Buy and download
Check out with card, Apple Pay or Google Pay. Your download buttons appear straight away and the links are emailed to you. Links work for 3 months, so save your copies.
Make it yours
Open it in Microsoft Word or Excel. Add your logo, business details, site and job information, and adjust it to how the work is done.
Brief your crew
Talk it through with the workers doing the job, have them sign on, and keep it on site. Review it whenever the job or conditions change.
What format is it?
Microsoft Word. Edit it in Word, or free in Word for the web, and add your own logo and business details.
How do I get it after I pay?
Your download buttons appear as soon as checkout finishes, and the links are emailed to you. You can re-download from your account at any time.
Is it compliant with Queensland law?
It's written around Queensland's Work Health and Safety Act 2011 and Regulation 2011. Tailor it to your site, consult your workers and review it whenever conditions change; no template can guarantee compliance on its own.
What if it isn't right for my job?
If it doesn't match its description or has a fault, tell us and we'll fix it. If you're still not happy, we'll refund you or give you store credit, your choice. Check the sample pages first, as we don't refund a change of mind.
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