DA Form 285-W at a glance
What it is: DA FORM 285-W is the Technical Report of U.S. Army Ground Mishap, a Summary of Witness Interview.
Who signs: If confidentiality was requested by the witness, interviewer sign and date the statement that the witness made this statement under a promise of confidentiality.
A filled-in DA Form 285-W example: a mishap investigator records a witness interview
How to fill out DA Form 285-W, box by box
The witness, boxes 1 to 6
In box 1, enter the name of the witness (last, first, MI).
In box 2, enter the occupation or title.
In box 3, enter the grade; in box 4, the date of birth.
In box 5, enter the address. Include the ZIP code; if military, include the organization.
In box 6, enter the telephone number (duty/work).
The interview, boxes 7 to 10
In box 7, enter the date of interview as YYYYMMDD.
In box 8, enter the experience and background.
In box 9, enter the location at time of accident.
In box 10, enter the interviewer (name and grade).
Promise of confidentiality, box 11
A promise of confidentiality can only be offered in Limited Use Investigations, which normally are not ground accidents. For exception, see AR 385-10, paragraph 3-10.
Was a promise of confidentiality offered to the witness? If yes, read blk 14a. to the witness and complete blk 15. If no, read blk 14b. to the witness.
Confidentiality was requested by the witness: Yes or No. If yes, interviewer sign and date the statement under this box: signature of interviewer and date (YYYYMMDD).
Summary of interview and date of accident, boxes 12 and 13
In box 12, enter the summary of interview.
In box 13, enter the date of accident as YYYYMMDD.
Availability of promise of confidentiality, box 15
Availability of promise of confidentiality for limited use report of investigation: witness, please indicate which option you desire by initialing one of the choices in box 15.
One of the choices: I request a promise of confidentiality.
If you do not wish a promise of confidentiality, you may decline such. 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.
Under Name of witness, print the name; do not sign.
Confidentiality means that your interview will not be released to the public or outside DoD safety channels.
More rules for DA Form 285-W
The form is used to interview witnesses, which is an integral part of the investigation process, if there are witnesses present. For additional information, see the System of Records Notice A0385-1040 ASO, https://www.federalregister.gov/documents/2020/02/27/2020-03949/privacy-act-of-1974-system-of-records.
For use of this form, see DA Pamphlet 385-40; the proponent agency is DAS.
Disclosure: Voluntary. However, the use of witness information is a critical part of the overall investigation process. Failure to provide the information will interfere with the mishap investigation.
General witness information briefing: the interviewer must read the appropriate instructions to the witness.
Sources
[1] DA Form 285-W (JUL 2023), Technical Report of U.S. Army Ground Mishap, Summary of Witness Interview, U.S. Army (the Official source link on this page).
