Code: ACA-E 2 WITNESS DISCLOSURE FORM Name of witness:_________________________________________________ Position/Grade 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:________________________________ Adopted: 8/18/20 |