Department of

Human Resources

Our Goal is to ensure that we provide the best possible service to our current employees, prospective employees, retirees, and the citizens of Racine, thus making the City an employer of choice and a great place to work! We are responsible for personnel services and policies and overall employee relations for the City of Racine. We are dedicated to providing quality service to current employees, as well as to individuals seeking employment with the City.

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Wellness Incentive Program

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Witness Statement Form

Documenting Important Details with Care

Use the Witness Statement Form to provide a clear and accurate account of an incident. Your input is vital in ensuring a fair and thorough review process.

Doctor examining a young girl with her mother present. The girl is smiling and reaching towards the doctor.

CITY OF RACINE Witness Statement Form

Fax This Form to Human Resources at 262-636-9585

Witness Name(Required)

Witness First Name Witness Last Name

Address(Required)

Address Line 1 Address Line 2 City State / Province / Region ZIP / Postal Code

Home Phone(Required)

Date of Birth(Required)

Email(Required)

Person(s) Working With(Required)

Date of Injury:(Required)

Time of Injury(Required)

Area of Injury(Required)

Specify(Required)

Type of Injury(Required)

Specify(Required)

Location of Incident(Required)

Other Witnesses(Required)

Describe What Happened(Required)

Witness Signature(Required)

Date Signed(Required)

Supervisor Signature(Required)

Date Signed(Required)

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Download Witness Statement Form

About City of Racine Human Resources

Welcome to the City of Racine’s Human Resources Department. Our dedicated team is committed to empowering employees, fostering a positive and productive workplace, and recruiting top talent to serve our community. Learn more about our values, goals, and the services we provide to support the city’s continued growth and success.

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