Accident Witness Statement
University of Maryland Baltimore County
(to be completed within 24 hours of the accident)
Injury Information
Bldg. and Area (hall way, office, etc)
MM/DD/YYYY format
hh:mm AM/PM format
describe the work-process you were engaged in, give the purpose of the function or task, describe how the injury occured, and explain the cause
be specific - example: right middle finger, left ankle, upper back