502.10E2 - Witness Disclosure Form

Witness Disclosure Form

Name of witness: ________________________________________________

Position of witness: ________________________________________________

Date of testimony, interview: ________________________________________________

Description of incident witnessed: ________________________________________________

Any other information: ________________________________________________

I agree that all of the information on this form is accurate and true to the best of my knowledge. 

________________________________________________
Signature:                                

________________________________________________
Date: 

Approved:  11/16/2020                       Reviewed: 10/19/2020            Revised:   10/19/2020