Colorado Recreation Company

28368 Constellation Road #480 Valencia, CA 91355

Ph: (805) 285-3229 Fax: (805) 285-2056

Employee Witness Statement Form – Accidents and Incidents

Describe what happened in full detail. If you need extra space, please attach other pieces of paper to this form in order. If

this is rejected by your manager, please contact the Main Office to submit this form.

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Employee Signature Date