Accident Witness Statement
(To be completed by accident witness)
Employer: University of Maryland
Employee: (First)
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
Signature of witness:
Fax Immediately to: EHS Risk Management (410)706-8212 Revised: 09/19