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The Employee Statement form plays a crucial role in the internal investigative process within the Department of Correction. Designed to collect personal accounts related to disciplinary matters, this form requires specific information from the employee providing the statement, including their name, position number, location, and classification. It emphasizes that all responses must be handwritten for authenticity, ensuring clarity and personal accountability. The form also serves as a reminder of the importance of honesty, outlining that failure to cooperate or providing misleading information can lead to serious consequences, including dismissal. Additionally, employees are encouraged to mention any witnesses who may offer relevant information regarding the incident. It is essential for participants to understand that their statements are a vital part of the official investigation and that they may be required to provide further clarifications or testify. The final touch that underscores the significance of the document is the requirement for an original signature and date, which confirms the authenticity of the claims made within the statement.

Employee Statement Example

EMPLOYEE/WITNESS STATEMENT FORM

In accordance with the Department of Correction Disciplinary Policy and Procedures, failure to cooperate with or hindering an internal investigation, including the refusal to answer questions, and providing false or purposefully misleading information during an internal investigation constitutes unacceptable personal conduct and may result in discipline up to and including dismissal.

DIRECTIONS: DO NOT TYPE. MUST BE HANDWRITTEN BY EMPLOYEE. PLEASE WRITE CLEARLY. FORM MUST CONTAIN AN ORIGINAL SIGNATURE OF EMPLOYEE SUPPLYING STATEMENT.

NAME:

POSITION NUMBER:

LOCATION:

CLASSIFICATION:

STATEMENT: (Use additional paper or back of form if necessary)

Please list any witnesses or individuals who may have information relative to this investigation.

I understand this statement will be considered part of the official investigation and that I may be called on to testify or provide written or verbal clarifying statements. The statement I have provided is an accurate account of the case to the best of my knowledge.

Signature

Date

08/20/04

Form Characteristics

Fact Name Description
Purpose The form is used to collect statements from employees or witnesses involved in an internal investigation.
Handwritten Requirement Employees must fill out the form by hand. Typed submissions are not accepted.
Signature An original signature is required from the employee making the statement. No digital signatures or copies allowed.
False Statements Providing false or misleading information can lead to disciplinary action, which may include dismissal.
Witness Information Employees are encouraged to list any witnesses who may provide relevant information regarding the investigation.
Governing Law The form adheres to the Department of Correction Disciplinary Policy and Procedures.
Date The date on the form must indicate when the statement was completed; in this case, it is 08/20/04.
Confidentiality Statements are considered part of the official investigation and may be used in legal proceedings.

Guidelines on Utilizing Employee Statement

Completing the Employee Statement form is an essential step in the investigative process. This form must be filled out accurately and handed in promptly. It is critical that you carefully follow the steps outlined below to ensure your submission is valid and taken seriously.

  1. Gather Necessary Information: Before filling out the form, collect all relevant details, such as your name, position number, and location.
  2. Prepare Your Writing Tools: Use a pen. This form must be handwritten; typing is not allowed.
  3. Fill in Personal Information: Write your name, position number, location, and classification clearly in the designated spaces.
  4. Draft Your Statement: In the statement section, provide an accurate account of the situation as you understand it. If necessary, use additional paper or the back of the form for more space.
  5. List Witnesses: If there are any witnesses or individuals with relevant information, be sure to include their names.
  6. Review Your Statement: Double-check your handwriting for clarity. Ensure that all information is complete and correct.
  7. Provide Your Signature: Sign and date the form at the bottom. Ensure that the signature is original and not a photocopy.

Once you have completed the form, submit it to the appropriate individual or department as directed. Timely submission will help facilitate the investigation process. Ensure you keep a copy for your records if needed in the future.

What You Should Know About This Form

What is the purpose of the Employee Statement form?

The Employee Statement form is designed to collect accurate and detailed information from employees regarding specific incidents or circumstances under investigation within the Department of Correction. It serves as an official record that can be used during internal investigations to ensure fairness and accountability.

Who needs to fill out this form?

Any employee who is involved in or has relevant information regarding an internal investigation is required to complete this form. This includes both witnesses and individuals directly connected to the incident in question.

How should the form be filled out?

It is important to handwrite your responses clearly on the form. Typed responses are not accepted. You can use additional paper if necessary to fully convey your statement. Ensure you sign the form at the end to validate the information provided.

What information is required on the form?

You will need to provide your name, position number, location, classification, and a detailed statement of the incident. Additionally, list any witnesses or individuals who may have pertinent information regarding the investigation.

What happens if I do not fill out the form?

Failure to cooperate, which includes not completing the Employee Statement form, can be seen as hindering the investigation. This may lead to disciplinary action, which could range from reprimands to dismissal depending on the severity of the circumstances.

Will my statement be kept confidential?

Your statement will be considered part of the official investigation. While there are policies to maintain confidentiality, the nature of investigations may require that some information is shared with relevant parties involved in the process.

What should I do if I remember additional information after submitting the form?

If you recall more details after your submission, you should communicate this information to the person managing the investigation. You may be asked to provide a supplemental statement, and it's important to keep the investigation informed with accurate information.

What is the significance of the original signature?

The original signature on the Employee Statement form is crucial. It validates your account and indicates that you acknowledge the statement is accurate to the best of your knowledge. This signature may also be important if you are required to testify or clarify your statements in the future.

Can the information I provide be used against me?

While the information you provide in the Employee Statement form is intended for the investigation, any inconsistencies or false information may lead to disciplinary actions. It is important to be truthful and precise in your account to avoid potential repercussions.

Common mistakes

Completing the Employee Statement form is a crucial process that can significantly impact the outcome of an internal investigation. However, individuals often make mistakes that can lead to confusion or complications. One common error is neglecting to follow the direction that specifies the form must be handwritten. When individuals type their responses, the submission is not only invalidated but could also delay the investigation process.

Another mistake is failing to write clearly. Illegible handwriting can result in misinterpretations of critical information. It is essential to ensure that every letter and word is easily readable. Not only does clear handwriting facilitate the understanding of the statement, but it also demonstrates respect for the investigation process.

Individuals sometimes forget to provide their original signature on the form. This requirement is mandatory, and omitting a signature can lead to the form being rejected. All parties involved in the investigation need to have a signed document to ensure its legitimacy, thus individuals must double-check to include their name and signature.

Another issue arises when individuals do not provide complete information in the statement section. Vague responses can lead to further questions and may prolong the investigation. Providing specific details, including dates, locations, and people involved, ensures that the account is as comprehensive as possible.

Failing to list witnesses can also pose problems. If there are individuals who can shed light on the situation, their names should be included. This action can facilitate a thorough investigation and may provide essential insights into the matter at hand.

Moreover, some individuals may misinterpret the significance of their statements. It is vital to remember that the submitted information is part of the official investigation. Consequently, any unintentional misinformation can create barriers and raise concerns about credibility. Ensuring the accuracy of the account is paramount, as it holds significant weight in the proceedings.

Lastly, a common oversight is not being aware of potential follow-ups after the submission of the statement. Individuals often assume that their role ends with the completion of the form. In reality, they may be called upon to provide further clarification or even testify. Understanding this possibility helps in preparing for the next steps in the process.

Documents used along the form

When completing the Employee Statement form, it's important to consider additional documents that may be required during the investigation process. These documents can help clarify the situation and ensure that all necessary information is gathered. Below is a list of commonly used forms and documents that complement the Employee Statement form.

  • Incident Report: This document outlines the specifics of the incident being investigated, providing essential details like time, date, location, and a description of what occurred.
  • Witness Statement: Witnesses provide their accounts of the incident through this form. It acts as a supplementary document to gather different perspectives.
  • Disciplinary Action Form: If an investigation leads to disciplinary measures, this form is used to document the decision and actions taken.
  • Employee Warning Notice: Used to formally notify an employee about inappropriate conduct or policy violations, detailing the expected corrective actions.
  • Investigation Summary Report: This comprehensive report consolidates findings from the investigation and may include conclusions and recommendations for action.
  • Evidence Submission Form: This form is used to submit any physical evidence related to the incident, such as photographs, documents, or recordings.
  • Confidentiality Agreement: This ensures all parties involved in the investigation understand the importance of keeping information private and secure.
  • Employee Performance Evaluation: Although not directly related, this document can provide insights into the employee's past performance and behavior in the workplace.

Having these documents on hand can facilitate a smoother investigation process. They help provide a clearer picture of the situation and ensure that all relevant information is considered. Make sure to approach all forms with care and accuracy to support a fair investigation.

Similar forms

  • Incident Report: Similar to the Employee Statement form, an incident report is a detailed account describing an event or situation. Both documents require firsthand narratives and may include witness information to support the investigation process.
  • Witness Statement: A witness statement captures the observations of individuals not directly involved in a situation. Just like the Employee Statement, it seeks to gather accurate and personal accounts of events to establish a clear understanding of circumstances.
  • Affidavit: An affidavit is a written statement confirmed by oath. It parallels the Employee Statement in its commitment to truthfulness, where both documents can be used as official evidence in investigations or legal proceedings.
  • Statement of Facts: This type of document outlines the key facts surrounding an issue. Similar to the Employee Statement, it aims to present a clear account of events, ensuring that information is organized and concise.
  • Grievance Form: A grievance form allows employees to document complaints or disputes. Like the Employee Statement, it necessitates an accurate representation of experiences and concerns for proper resolution.
  • Testimonial Letter: A testimonial letter serves as an endorsement or recommendation from someone with knowledge of a person’s character or actions. This document, much like the Employee Statement, emphasizes the importance of personal experience and firsthand knowledge.
  • Inspection Report: An inspection report assesses compliance with established standards. Similar to the Employee Statement, it requires detailed observations to support findings and conclusions related to an incident.
  • Performance Review: A performance review evaluates an employee’s work performance, often including written statements about achievements and areas for improvement. Both documents rely on accurate information to inform future decisions and actions.
  • Interview Notes: Interview notes document the details of conversations conducted during investigations. Like the Employee Statement, these notes capture essential information and perspectives for thorough analysis of the situation.

Dos and Don'ts

When filling out the Employee Statement form, there are key actions to consider to ensure clarity and compliance with the requirements. Below is a list of things you should and shouldn't do:

  • Do handwrite your statement. The form must be filled out in your own handwriting.
  • Do write clearly. Ensure that your writing is legible to avoid misunderstandings.
  • Do include an original signature. The form must contain your actual signature, not a digital one.
  • Do provide accurate information. Make sure your statement is truthful and as complete as possible.
  • Do list potential witnesses. Mention any individuals who might have valuable information regarding the investigation.
  • Don’t leave sections blank. Fill out all required fields, including your name, position number, and location.
  • Don’t provide false information. Misleading or false statements could result in disciplinary action.

Following these guidelines will help ensure your statement is accepted and assists the investigation process effectively.

Misconceptions

Misconceptions about the Employee Statement form can lead to confusion during an internal investigation. Here are some common misunderstandings:

  • Only Employees Need to Fill It Out: Some believe only the employee involved must complete the form. However, witnesses may also need to provide statements.
  • Typed Statements Are Acceptable: A common myth is that typing the statement is permissible. The form specifically requires handwritten submissions to ensure authenticity.
  • Signature Can Be Digital: Many think they can sign the form digitally. In reality, an original handwritten signature is mandatory.
  • Content Doesn't Matter If Not Tied to Conduct: Some may think that if their statement doesn't directly relate to misconduct, it isn't important. However, all relevant information can provide crucial context.
  • Misleading Information is Allowed: There is a misconception that providing misleading information is acceptable. In fact, this behavior may lead to serious disciplinary action.
  • You Can Remain Anonymous: Some individuals believe they can submit statements anonymously. However, identifying the author is essential for follow-up questions and clarifications.
  • Witness Information is Optional: Some think they can omit witness details. Listing witnesses can strengthen the statement and support the investigation.
  • Form is Not Part of Official Record: Lastly, there's a belief that the statement is informal. In reality, it becomes part of the official investigation record and could be used in hearings.

Understanding these misconceptions can help ensure a smoother and more transparent investigation process.

Key takeaways

Filling out the Employee Statement form is a crucial step in contributing to an internal investigation. Here are some key takeaways to keep in mind:

  • The form must be filled out by hand; typing is not permitted. This ensures authenticity and highlights the importance of the statement.
  • It is essential to write clearly. Legibility is critical as the information will be reviewed in the context of an investigation.
  • Your original signature is required on the form. This act confirms that the information provided is your own and adds credibility to your account.
  • Be thorough in your statement. If additional space is needed, you may use the back of the form or attach extra paper to ensure all relevant details are included.
  • Consider potential witnesses. Listing individuals who may provide corroborating information strengthens your statement and the overall investigation.

Remember, the information you provide will be an integral part of the investigation process. Being truthful and cooperative can significantly impact the outcome for all parties involved.