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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City Of Racine Witness Statement Form

Ensuring Your Safety and Well-being

The City is committed to your safety at work. Explore our workers’ compensation resources to learn about your rights and the support available in case of workplace injuries or illnesses.

City of Racine Witness Statement

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)

URL

This field is for validation purposes and should be left unchanged.

Download Form PDF

Download Witness Statement

150.7 KB

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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