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The DA 285 W R form is an essential document used by the U.S. Army for accident reporting and witness interviews. When an accident occurs, it is crucial to gather information from witnesses to aid in safety investigations. This form plays a vital role in that process by collecting various details about witnesses, including their names, occupations, and experiences at the time of the incident. It also addresses the important issue of confidentiality. Witnesses have the option to request confidentiality, which ensures that their statements are used strictly for safety evaluation and will not be disclosed publicly. Furthermore, the form outlines the protocols established under Army Regulation 385-40, guiding the investigation to prioritize accident prevention over disciplinary actions. The DA 285 W R form serves not just as a record, but as a safeguard for those who provide critical information, encouraging a culture of safety within the military.

Form Sample

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

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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

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Document Specifications

Fact Name Description
Purpose of the Form The DA 285 W R form is utilized to document witness interviews as part of the U.S. Army's accident investigation process, focusing on safety and accident prevention.
Regulatory Reference This form is governed by Army Regulation (AR) 385-40 and the Department of the Army Pamphlet 385-40, which outline procedures for safety investigations.
Witness Information Required The form requires various personal details from the witness, such as name, occupation, age, address, and contact information.
Confidentiality Options Witnesses can request confidentiality for their interviews, which protects the information from public release under the Freedom of Information Act.
Interview Purpose Interviews conducted using this form are intended solely for improving safety protocols and cannot be used for disciplinary action.
Final Report Usage The final accident report will include a summary of the witness interviews, available for review by the chain of command, solely for safety and accident prevention purposes.

Steps to Filling Out Da 285 W R

The DA 285 W R form is essential for documenting witness interviews related to U.S. Army accident investigations. Completing this form accurately is vital for ensuring that the information gathered is used correctly and protects the rights of the witness. Follow these systematic steps to fill out the form comprehensively.

  1. Witness Information: In the first section, enter the name of the witness. Use the format Last, First, MI.
  2. Occupation and Grade: Fill in the witness's occupation or title, followed by their grade.
  3. Social Security Number: Enter the witness's Social Security Number (SSN).
  4. Age: Provide the witness's age.
  5. Address: Include the full address of the witness, ensuring to add the ZIP code. If the witness is military, include their organization.
  6. Telephone Number: Write down the contact number for the witness.
  7. Date of Interview: Note the date when the interview took place.
  8. Experience and Background: Describe the witness's relevant experience and background related to the incident.
  9. Location at Time of Accident: Specify where the witness was at the time of the accident.
  10. Interviewer: The person conducting the interview should write their name here.
  11. Confidentiality Section: Indicate whether a promise of confidentiality was offered to the witness. Circle "Yes" or "No." If "Yes," read Block 15a and complete Block 16. If "No," read Block 15b.
  12. Confidentiality Request: Inquire if the witness wants confidentiality. Record their response and ensure the interviewer signs and dates below if the witness requested confidentiality.
  13. Summary of Interview: Provide a detailed summary of the interviewer's conversations with the witness.
  14. Date of Accident: Enter the date of the accident in the format YYMMDD.

More About Da 285 W R

What is the DA 285 W R form used for?

The DA 285 W R form is an Accident Report used by the U.S. Army to document witness interviews during safety investigations. Its primary aim is to gather information to prevent future accidents and improve safety protocols within the Army. This form helps provide a clear account of witness statements and experiences related to a specific incident.

Who should fill out the DA 285 W R form?

The form should be filled out by the interviewer conducting the witness interview, not the witness themselves. The interviewer is responsible for collecting the necessary information and ensuring the witness understands the purpose of the interview, including the promise of confidentiality options available to them.

What information is required from a witness on this form?

The form requires various details from the witness, including their name, occupation, grade, social security number, age, address, telephone number, date of the interview, and their experience and background. It also asks for the witness's location at the time of the accident and details about the summary of the interview conducted. All this information helps in documenting the witness's perspective on the accident.

Can a witness request confidentiality during their interview?

Yes, a witness can request confidentiality. If a promise of confidentiality is granted, the details of the interview will not be released to the public and will only be used for accident prevention within military channels. This option protects the witness's identity and statements from public disclosure.

What happens if a witness declines the confidentiality option?

If a witness declines the option for confidentiality, their statements may still be used for accident prevention within the military. However, they acknowledge that their information could be released to the public under the Freedom of Information Act. This means the summary of their interview may be available to anyone outside the military.

How is the information from the DA 285 W R form utilized?

The information collected on this form is utilized for safety investigations to help prevent future accidents. It may provide crucial insights for understanding how an accident occurred. However, it's important to note that the findings from these interviews cannot be used for disciplinary actions against any individuals involved.

Are the witness interviews part of a larger investigation?

Yes, witness interviews documented on the DA 285 W R form are often part of a broader investigation. Multiple investigations may be conducted simultaneously, including safety and legal investigations. Each type of investigation serves a different purpose, but all aim to understand the circumstances surrounding the accident.

What should witnesses do if they suspect their interview was misused?

If witnesses believe their interview was used for purposes other than accident prevention—such as disciplinary action—they should reach out to their local Judge Advocate Defense Counsel Office. They can also request that the Command Judge Advocate at the U.S. Army Safety Center is notified about their concerns.

What kind of confidentiality assurances does the form provide?

The form assures witnesses that their interviews, if conducted under a promise of confidentiality, will not be shared with the public. The information will be used strictly for safety and accident prevention within the military. This assurance is crucial for building trust during the interview process, encouraging honest and complete witness statements.

Common mistakes

  1. Not providing full names for all witnesses. Ensure you include the last name, first name, and middle initial as required.

  2. Leaving the occupation/title field blank. This information is essential for understanding the witness's perspective.

  3. Completing the grade section incorrectly. Use the appropriate military or civilian grade to avoid confusion.

  4. Missing the Social Security Number. This requirement must be fulfilled to properly identify the witness.

  5. Providing an incorrect or incomplete address. A full address, including ZIP code, is crucial for record-keeping.

  6. Omitting the date of interview. Always include the correct date to ensure chronological accuracy.

  7. Failing to specify the location at the time of the accident. This detail helps in understanding the circumstances surrounding the event.

  8. Forgetting to indicate whether a promise of confidentiality was offered. This information is vital for protecting witness statements.

  9. Not summarizing the interview accurately. An exhaustive, clear summary aids in the overall investigation process.

  10. Neglecting to sign and date the interviewer's statement. This step confirms the integrity of the witness's statement.

Documents used along the form

The DA 285 W R form is part of the documentation used for reporting accidents in the U.S. Army. Various other forms accompany this document to ensure thorough record-keeping and information collection. Below are eight commonly used forms and documents that may be utilized alongside the DA 285 W R form.

  • DA Form 285: This is the standard U.S. Army Accident Report. It provides a comprehensive overview of the accident, including details about the incident, parties involved, and witness accounts.
  • DA Form 2028: This form is used for submitting recommendations for changes or updates to Army publications and forms. It may be relevant if issues with the DA 285 W R form arise during the reporting process.
  • DA Form 8000: This form documents safety-related actions and serves as a safety recommendation form. It helps in tracking safety measures following an accident.
  • AF Form 5: This Air Force form is used to report incidents pertaining to aviation safety. It can provide context if the accident involves aircraft or aviation operations.
  • DD Form 1408: This form is a traffic ticket issued by a military police officer. It might be completed if the accident involves any violation of traffic laws on military installations.
  • SF 91: This is the accident report form for both civilian and military motor vehicle accidents. It is relevant if the incident involves vehicles.
  • DD Form 2276: This form records the details of an Army accident investigation board. It helps track findings and recommendations from the investigative process.
  • DA Form 1059: This form provides academic evaluation reports. It may be necessary if the accident has implications for training or educational programs within the Army.

These forms and documents work together to create a complete picture of the events surrounding an accident. It is imperative that all relevant details are recorded accurately to ensure proper follow-up and maintain safety protocols.

Similar forms

The DA Form 2823, known as the Sworn Statement form, serves a purpose similar to the DA 285 W R. It is used within the military to collect testimonies under oath. This form ensures that the statements made are considered official and can be used in legal or disciplinary proceedings. Like the DA 285 W R, confidentiality is a key consideration; however, a sworn statement provides a legal backing that may not always be present in informal witness interviews.

The DA Form 3946, also referred to as the Field Record of Proceedings form, is used during investigations and captures essential data in a structured manner. Both forms require details about the witness and the accident. However, the DA 3946 is more often used in formal investigations with legal implications, while the DA 285 W R focuses more on safety and accident prevention interviews.

The AF Form 1168, which is the Statement of Suspected Criminal Activity form, also resembles the DA 285 W R in capturing witness accounts. While the AF Form 1168 is specifically tailored for criminal investigations, it shares the same goal of documenting experiences and observations during an incident. Both forms are vital in ensuring accurate reporting, but the AF Form 1168 is more aligned with criminal law.

The DD Form 1920, the Alcohol Incident Report, has similarities with the DA 285 W R, particularly in gathering testimony related to incidents involving alcohol. Both forms seek to document details to understand the circumstances better. However, the DD Form 1920 focuses specifically on incidents related to alcohol use, often in a disciplinary context, while the DA 285 W R is broader in addressing general safety concerns.

The DA Form 250, referred to as a Material Inspection and Receiving Report, serves as an official record that can include eyewitness accounts of material conditions. While it focuses more on property accountability and condition reports, both forms gather crucial information to support investigations, though their applications vary significantly, with the DA 285 W R aimed at accident prevention.

The SF 95, which is the Claim for Damage, Injury or Death form, has some parallels with the DA 285 W R. This document addresses incidents where unauthorized actions lead to claims for damages. It captures witness accounts much like the DA 285 W R, but its primary function pertains to legal claims, adding another layer of complexity that is usually absent in safety investigations.

The DA Form 7440, used for Accident Reporting, is also similar to the DA 285 W R in that it encompasses findings from accident investigations. Both forms seek to improve safety and reduce the likelihood of future incidents. However, the focus on formal accident reporting in DA Form 7440 means it often involves predetermined assessments, while the DA 285 W R prioritizes initial, informal witness interviews.

The DoD Form 2950, related to Hazardous Material Incident Reports, shares commonality in that it collects narratives about incidents involving hazardous materials. While the DA 285 W R emphasizes overall accident investigation, the DoD Form 2950 is highly specialized, aimed specifically at preventing and managing hazardous material incidents.

The FS Form 2450, the Fire Incident Report, captures details on fire-related occurrences. Similar to the DA 285 W R, this form gathers information from witnesses to understand what transpired. The focus is narrowed to fire incidents, contrasting with the DA 285 W R’s broader intent of overall safety, though accident prevention is a shared aim.

Finally, the DA Form 1, which serves as the Commander’s Assessment form, has a level of similarity in the information it seeks about incidents and personnel involved. While the DA Form 1 primarily reflects a leader's views and assessments, the DA 285 W R focuses on collecting firsthand accounts from witnesses. Both are critical for understanding incidents, but their purposes and authors vary.

Dos and Don'ts

When filling out the DA 285 W R form, here are five things you should do:

  • Provide accurate personal information, including your full name, occupation, and contact details.
  • Clearly note the date of the interview and the date of the accident.
  • Be honest in your summary of the interview and share relevant experiences.
  • If confidentiality is desired, clearly indicate that preference.
  • Follow all instructions carefully to ensure compliance with Army regulations.

There are also five things you should not do:

  • Do not omit important details that could impact the investigation.
  • Do not provide misleading or false information during your interview.
  • Do not forget to sign and date your statement to validate your contribution.
  • Do not leave any sections blank; every question should be answered to the best of your knowledge.
  • Do not ignore the implications of confidentiality; understand your rights before signing anything.

Misconceptions

Understanding the DA 285 W R form can be challenging, especially with the various misconceptions that surround it. Here are some common misunderstandings regarding this important document:

  • Confidentiality is always guaranteed. Many people believe that all witness interviews conducted using this form come with a promise of confidentiality. However, confidentiality must be explicitly requested by the witness and is not automatically provided.
  • The form is solely for disciplinary action. Another common misconception is that the DA 285 W R form serves as a tool for disciplinary measures. In reality, the form is primarily intended for safety investigations aimed at accident prevention and cannot be used for disciplinary actions.
  • Witnesses are not allowed to decline confidentiality. Some individuals might think that they have no choice but to accept the confidentiality offering. On the contrary, witnesses can either accept or decline this option based on their comfort level.
  • Interviews can be used outside military purposes. There is a belief that information gathered through the DA 285 W R form can be accessed or used in legal contexts outside the military. This is inaccurate, as the form's content is restricted to accident prevention purposes within the military framework.
  • Investigation results are not reviewed by the chain of command. A misconception exists that the chain of command is uninvolved in the investigation process. In fact, while the chain of command will review the final accident report, it is important to note that they may only use it for safety and accident prevention.
  • Witness interviews hold no value. Some may think that interviews conducted using this form lack significance. This is a misunderstanding. The information shared can greatly contribute to improving safety measures and preventing future accidents.

Key takeaways

When filling out and using the DA 285 W R form, there are several critical points to keep in mind to ensure proper use and compliance. Here are nine key takeaways:

  • The Purpose: This form is specifically used for collecting witness information during a U.S. Army accident investigation. It focuses on safety and prevention.
  • Witness Information: Accurate details are essential. Fill out sections like the witness’s name, occupation, and address completely to establish credibility.
  • Promise of Confidentiality: Witnesses should understand their rights regarding confidentiality. A promise can protect their statements from public release, ensuring they are used only for accident prevention.
  • Understanding the Process: The interviewer must explain that the investigation aims to enhance safety, and is separate from any legal proceedings.
  • Freedom of Information Act: Non-confidential interviews may be subject to public release under the Freedom of Information Act. Witnesses need to be informed about this possibility.
  • Chain of Command Review: Although the chain of command will review the accident report, their use of the report will strictly align with safety and accident prevention.
  • Rejecting Confidentiality: If a witness declines a promise of confidentiality, their information might still be accessible to the public, highlighting the importance of this decision.
  • Legal Guidance: If a witness feels their interview has been misused for purposes beyond accident prevention, they are encouraged to seek legal advice promptly.
  • Completion and Signature: Ensure that the interviewer signs and dates the form after noting the confidentiality agreement. Proper closure of the interview process is crucial for validity.