Use this questionnaire and statement form to gather information from a witness with respect to an automobile accident in Canada. The questionnaire includes sections dealing with:

• the witness' position in relation to the accident, and distance from the scene;
  
• details about the person(s) and vehicle(s) involved in the accident;
  
• directions and speed that the vehicles were traveling;
  
• details that the witness observed or heard at the time, such as lane changes, signaling, braking, turning, horns, screeching tires, etc.;
  
• details about bad weather or other factors which could have had an effect.

The witness must make a declaration that the statement is true, under penalty of perjury.

This is a Canadian form in MS Word format.