Legal and management GA21 Witness statement cit Company name Project title Location Contract no. Namo of witness Date of incident are Occupation Statement Page of ‘This statement (consisting of false or do not believe tobe true, ages, each signed by me) is true to the best of my knowledge and belef and | make itknowing that, if tis tendered in evidence, | shall be liable to prosecution i have wifuly stated in it anything that | know to be Name Position Signature Dato: ‘Signature witnessed by Name Position Signature Date: © Construction Industry Training Board 2016, Construction site safety (GE 700} pubicaton