INCIDENT/ ACCIDENT INTERVIEW STATEMENT

PROJECT :
DATE :
NAME OF INTERVIEWEE :
DESIGNATION :
WORK PERMIT NO. :
ADDRESS IN SINGAPORE

REF: INCIDENT/ ACCIDENT OF:

INTERVIEW STATEMENT:

COMMENTS FROM INTERVIEWEE:

Signature of Interviewee, Certifying above statement Name & Signature of Interviewer,

to be true and correct, Date Date

Signature of Interpreter, Date

08 January 2018 HSE-03-6.2/ Rev 00

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