Workers comp witness statement form 2026

1. Click ‘Get Form’ to open the workers comp witness statement form in the editor.
2. Begin by entering the Injured Worker’s Name in the designated field. This is crucial for identifying the individual involved.
3. Next, fill out the Witness Details section. Provide your name, date of birth, address, phone number, employer’s name, occupation, and your relationship to the injured worker. Choose from options like co-worker or family.
4. In the Incident Details section, specify the date and time of the incident. Describe where it occurred and detail the type and location of injury. Indicate whether you were an eyewitness and provide a description if applicable.
5. Finally, complete the Declaration section by signing and dating the form to affirm that all information provided is accurate.

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