Neutral fact-gathering form

Give employees room to describe events in their own words.

This form organizes dates, locations, people present, and a first-person account without embedding conclusions or leading questions. Use it as one part of a fair, consistent fact-finding process.

Best for: Managers collecting an employee’s account of a workplace event or concern.

I understand these materials are examples for demonstration purposes, not legal advice, and should be reviewed before distribution.

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Neutral fact-gathering form

Employee account of a workplace event

Invite a first-person account. Leave fields blank when they do not apply; do not suggest conclusions or answers.

Employee name Statement prepared on Date and approximate time of event Work location or area People who may have relevant information

In your own words, what happened? Include what you personally saw, heard, or did. Identify anything you learned from someone else. Is there other context or material you want the reviewer to consider? Do not include diagnoses or unrelated private details. Is there anything you want to correct or clarify after reviewing your account?

Employee signature Date Received by Date

Handle this statement under your approved access, retention, and preservation procedures. Do not promise confidentiality or a particular outcome. Route medical, leave, accommodation, injury, or other sensitive information through the designated process.

Invite an account, do not supply one

Use open prompts and allow the employee to distinguish what they personally saw or heard from what someone else told them. Do not suggest the answer or ask the employee to adopt a manager’s summary.

Keep notes factual and limited

Record the date, location, people identified, and the employee’s own account. Do not solicit diagnoses or unrelated personal information on this form. Route leave, accommodation, injury, or other confidential information through the appropriate process.

Preserve corrections and related material

Let the employee review the written account for transcription errors and record corrections without erasing the original. Handle statements and attachments under your approved access, retention, and preservation procedures.

Do not promise confidentiality

Explain who may need to review the statement and how it will be handled under your policy. Avoid promising secrecy or a particular employment outcome. Seek legal advice before using a statement in a high-risk or contested matter.

Manager checklist

Record when and where the event occurred and who may have relevant information.
Ask for the employee’s own account in their own words.
Separate firsthand observations from secondhand information.
Offer a chance to clarify factual transcription errors.
Keep medical and other sensitive details out of routine statement records.
Follow counsel-reviewed access, retention, and investigation procedures.