Da Form 285 W R PDF Details

Amid the complexities of maintaining safety and accountability within the U.S. Army, the DA Form 285-W-R emerges as a critical document, guiding the structured gathering of witness accounts following an accident. This form, also known as the U.S. Army Accident Report Requirements Control Symbol Summary of Witness Interview, plays a pivotal role in the army's efforts to analyze and prevent future incidents. The form is meticulously designed to capture a wide array of information, including the witness's personal details, their account of the accident, and their background, which may provide context to their testimony. A notable feature is the emphasis on confidentiality, offering witnesses the option to have their statements kept confidential or to understand the conditions under which their accounts may be shared. This careful balance of transparency and privacy underscores the army's commitment to both accident prevention and the protection of individual rights. Individuals are informed about the separate nature of safety investigations from other types of inquiries, such as legal or disciplinary actions, highlighting the form's exclusive focus on enhancing safety measures. Further, the form outlines the procedure for those seeking to keep their interviews confidential, ensuring that their contributions are used solely for the enhancement of safety and accident prevention within the military framework.

QuestionAnswer
Form NameDa Form 285 W R
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesSSN, ACDT, army ground accident report, 15b

Form Preview Example

U.S. ARMY ACCIDENT REPORT

REQUIREMENTS CONTROL SYMBOL

SUMMARY OF WITNESS INTERVIEW

CSOCS-308

For use of this form, see AR 385-40 and DA Pamphlet 385-40; the proponent agency is OCSA

 

 

 

1. NAME OF WITNESS (LAST, FIRST, MI)

2. OCCUPATION/TITLE

3. GRADE

4. SSN

5. AGE

6. ADDRESS (Include ZIP Code) (If military, include organization)

7. TELEPHONE NUMBER

8. DATE OF INTERVIEW

9. EXPERIENCE AND BACKGROUND

10. LOCATION AT TIME OF ACDT

11. INTERVIEWER

12. Was a promise of confidentiality offered to the witness? Yes No (If yes, read blk 15a to the witness and complete

blk 16. If no, read blk 15b to the witness.) Confidentiality was requested by the witness. Yes

 

No (If Yes, interviewer

sign and date statement below.)

 

 

 

 

 

THE WITNESS MADE THIS STATEMENT UNDER A PROMISE OF CONFIDENTIALITY.

 

 

 

 

 

 

 

 

Signature of Interviewer

 

Date

 

 

 

 

 

 

 

 

 

13. SUMMARY OF INTERVIEW

 

 

 

14. DATE OF ACCIDENT (YYMMDD)

DA FORM 285-W-R, JUL 94

USAPPC V1.00

15. GENERAL WITNESS INFORMATION BRIEFING (Interviewer must read appropriate instructions to the witness)

a. Promise of confidentiality offered.

(1)This accident investigation board has been convened under the provisions of AR 385-40 for the purpose of conducting a safety investigation.

(2)This may be just one of a number of investigations being conducted

regarding this accident; collateral or legal investigations may be ongoing as well. Those investigations are entirely separate from a safety investigation and are also required to inform you of their purpose and of your legal rights.

(3)This safety investigation is being conducted for accident prevention purposes only. Within the military, pursuant to Army Regulation 385-40, it cannot be used for any other purpose, to include any future disciplinary actions against any individuals. Therefore, the interview you are being asked to provide will be used by the Army in the interest of safety and accident prevention only.

(4)Nonconfidential witness interviews may be released to the public pursuant to a Freedom of Information Act request. If you wish to protect your interview from public release outside the military, then your interview must be pursuant to a promise of confidentiality. Confidentiality means that your interview will not be released to the public or outside DOD safety channels.

(5)Whether your interview is confidential or not, the chain of command will review the final accident report, which may include a summary of your interview, but the chain of command may only use the investigation report and the interviews for safety and accident prevention purposes.

(6)If you ever have knowledge that your witness interview was used by the Army for anything other than accident prevention purposes (for example, disciplinary action against an individual), you should consult with your local Judge Advocate Defense Counsel Office and request that the Command Judge Advocate, U.S. Army Safety Center, be notified at DSN 558-3960 or commercial (205) 255-3960.

(7)The promise of confidentiality is available to you if you desire it. Do you desire it?

b. No promise of confidentiality offered.

(1)This accident investigation board has been convened under the provisions of AR 385-40 for the purpose of conducting a safety investigation.

(2)This may be just one of a number of investigations being conducted regarding this accident; collateral or legal investigations may be ongoing as well. Those investigations are entirely separate from a safety investigation and are also required to inform you of their purpose and of your legal rights.

(3)This safety investigation is being conducted for accident prevention purposes only. Within the military, pursuant to Army Regulation 385-40, it cannot be used for any other purpose, to include any future disciplinary actions against any individuals. Therefore, the interview you are being asked to provide will be used by the Army in the interest of safety and accident prevention only.

(4)The chain of command will review the final accident report, which may include a summary of your interview, but the chain of command may only use the investigation report and the interviews for safety and accident prevention purposes. The interview summary may be released to the public pursuant to a Freedom of Information Act request.

(5)If you ever have knowledge that your witness interview was used by the Army for anything other than accident prevention purposes (for example, disciplinary action against an individual), you should consult with your local Judge Advocate Defense Counsel Office and request that the Command Judge Advocate, U.S. Army Safety Center, be notified at DSN 558-3960 or commercial (205)

255-3960.

16.AVAILABILITY OF PROMISE OF CONFIDENTIALITY FOR "LIMITED USE" REPORT OF INVESTIGATION

a.Pursuant to AR 385-40, witness interviews may only be used within the military for purposes of accident prevention, and may not be used as evidence in connection with any administrative or disciplinary proceeding.

This protection alone does not prevent release of the interview outside of the military (to the public, newspapers, attorneys, etc.) under the Freedom of Information Act. If you wish to protect your interview from release outside of the military, then your interview must be pursuant to a promise of confidentiality.

b. If you do not wish a promise of confidentiality, you may decline such below. In that case, your interview will still be used in the military only for purposes of accident prevention, but it may be released outside of the military in response to a Freedom of Information Act request. Please indicate which option you desire by initialing one of the choices below:

I request a promise of confidentiality. I understand that the results of my interview will be used within the military only for the purposes of accident prevention, and will also be protected from public release outside of the military under the Freedom of Information Act.

I decline a promise of confidentiality. I understand that the results of my interview will be used within the military only for purposes of accident prevention. I also understand that the results may be publicly released outside of the military under the Freedom of Information Act.

Name of witness (Print)

REVERSE OF DA FORM 285-W-R, JUL 94

Page 2

 

USAPPC V1.00

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Step 2: Once you have entered the editing page blk, you will be able to notice all the actions intended for your file in the upper menu.

You need to type in the following data so you can create the document:

285-W-R empty fields to consider

Note the required particulars in DATE OF ACCIDENT YYMMDD, DA FORM WR JUL, and USAPPC V part.

step 2 to filling out 285-W-R

Record any particulars you are required within the area b If you do not wish a promise of, I request a promise of, military only for the purposes of, I decline a promise of, military only for purposes of, Name of witness Print, REVERSE OF DA FORM WR JUL, and Page USAPPC V.

285-W-R b If you do not wish a promise of, I request a promise of, military only for the purposes of, I decline a promise of, military only for purposes of, Name of witness Print, REVERSE OF DA FORM WR JUL, and Page USAPPC V fields to complete

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