Fillable Accident Witness Statement (To be completed by accident (University of Maryland, Baltimore)

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Accident Witness Statement (To be completed by accident (University of Maryland, Baltimore)

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Country of origin: US
File type: PDF

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Accident Witness Statement
(To be completed by accident witness)
Employer: University of Maryland
Employee: (First)
(L
ast)
Location of accident Building: Area (hallway, etc.):
Date of accident: Time of accident:
Describe fully how accident occurred:
Describe bodily injury sustained (be specific about part(s) of body affected):
Name of witness: (Fi
rst) (Last)
Witness P
hone:
Signature of witness:
Date:
Fax Immediately to: EHS Risk Management (410)706-8212 Revised: 09/19
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Accident Witness Statement (To be completed by accident (University of Maryland, Baltimore)

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Completed 29 August 2020

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