DA Form 285-w Technical Report of U.S. Army Ground Accident - Summary of Witness Interview

What Is DA Form 285-W?

DA Form 285-W, Technical Report of U.S. Army Ground Accident Summary of Witness Interview is a form used for recording interviews with witness of accidents that happen on U.S. Army grounds. This form should be submitted along with all Class A and Class B accident reports.

The Department of the Army (DA) released the latest version of the form - sometimes confused with the DD Form 285, Appointment of Military Postal Clerk, Unit Mail Clerk or Mail Orderly - in February 2009. An up-to-date DA Form 285-W fillable version is available for download below or can be found on the Army Publishing Directorate (APD) website.

The DA 285-W must be used when interviewing all personnel involved or injured as the result of the accident. Any individual found to have a causal or contributing role in the accident must also be interviewed, if available. The investigator will emphasize to the witness that the sole purpose of the investigation is accident prevention.

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TECHNICAL REPORT OF U.S. ARMY GROUND ACCIDENT
REQUIREMENTS CONTROL SYMBOL
SUMMARY OF WITNESS INTERVIEW
CSOCS-308
For use of this form, see DA Pamphlet 385-40; the proponent agency is OCSA.
1. NAME OF WITNESS (LAST, FIRST, MI)
2. OCCUPATION/TITLE
3. GRADE
4. DATE OF BIRTH
5. ADDRESS (Include ZIP Code) (If military, include organization)
6. TELEPHONE NUMBER (Duty/Work)
7. DATE OF INTERVIEW (YYYYMMDD)
8. EXPERIENCE AND BACKGROUND
9. LOCATION AT TIME OF ACCIDENT
10. INTERVIEWER (Name and Grade)
11. Promise of confidentiality. 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.
a. Was a promise of confidentiality offered to the witness?
Yes
No
blk 15. If no, read blk 14b to the witness.)
b. 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 (YYYYMMDD)
12. SUMMARY OF INTERVIEW
13. DATE OF ACCIDENT (YYYYMMDD)
DA FORM 285-W, FEB 2009
PREVIOUS EDITION IS OBSOLETE.
PAGE 1 OF 2
APD AEM v1.00ES
TECHNICAL REPORT OF U.S. ARMY GROUND ACCIDENT
REQUIREMENTS CONTROL SYMBOL
SUMMARY OF WITNESS INTERVIEW
CSOCS-308
For use of this form, see DA Pamphlet 385-40; the proponent agency is OCSA.
1. NAME OF WITNESS (LAST, FIRST, MI)
2. OCCUPATION/TITLE
3. GRADE
4. DATE OF BIRTH
5. ADDRESS (Include ZIP Code) (If military, include organization)
6. TELEPHONE NUMBER (Duty/Work)
7. DATE OF INTERVIEW (YYYYMMDD)
8. EXPERIENCE AND BACKGROUND
9. LOCATION AT TIME OF ACCIDENT
10. INTERVIEWER (Name and Grade)
11. Promise of confidentiality. 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.
a. Was a promise of confidentiality offered to the witness?
Yes
No
blk 15. If no, read blk 14b to the witness.)
b. 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 (YYYYMMDD)
12. SUMMARY OF INTERVIEW
13. DATE OF ACCIDENT (YYYYMMDD)
DA FORM 285-W, FEB 2009
PREVIOUS EDITION IS OBSOLETE.
PAGE 1 OF 2
APD AEM v1.00ES
14. GENERAL WITNESS INFORMATION BRIEFING (Interviewer must read appropriate instructions to the witness)
a. Promise of confidentiality offered.
b. No promise of confidentiality offered.
(1) This accident investigation board has been convened under the
(1) This accident investigation board has been convened under
provisions of Army Regulation 385-10 for the purpose of conducting a
the provisions of AR 385-10 for the purpose of conducting a
safety investigation.
safety investigation.
(2) This may be just one of a number of investigations being conducted
(2) This may be just one of a number of investigations being
regarding this accident; collateral or legal investigations may be ongoing
conducted regarding this accident; collateral or legal investi-
as well. Those investigations are entirely separate from a safety
gations may be ongoing as well. Those investigations are
investigation and are also required to inform you of their purpose and of
entirely separate from a safety investigation and are also
your legal rights.
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 AR 385-10, it cannot be
(3) This safety investigation is being conducted for accident
used for any other purpose, to include any future disciplinary actions
prevention purposes only. Within the military, pursuant to AR
against any individuals. Therefore, the interview you are being asked to
385-10, it cannot be used for any other purpose, to include
provide will be used by the Army in the interest of safety and accident
any future disciplinary actions against any individuals.
prevention only.
Therefore, the interview you are being asked to provide will
be used by the Army in the interest of safety and accident
(3) Nonconfidential witness interviews may be released to the public pur-
prevention only.
suant to a Freedom of Information Act request. If you wish to protect
your interview from public release outside the military, then your inter-
(4) The chain of command will review the final accident report,
view must be pursuant to a promise of confidentiality. Confidentiality
which may include a summary of your interview, but the chain
means that your interview will not be released to the public or outside
of command may only use the investigation report and the
DoD safety channels.
interviews for safety and accident prevention purposes. The
interview summary may be released to the public pursuant to
(5) Whether your interview is confidential or not, the chain of command will
a Freedom of Information Act request.
review the final accident report, which may include a summary of your
interview, but the chain of command may only use the investigation
(5) If you ever have knowledge that your witness interview was
report and the interviews for safety and accident prevention purposes.
used by the Army for anything other than accident prevention
purposes (for example, disciplinary action against an
(6) If you ever have knowledge that your witness interview was used by the
individual), you should consult with your local Judge
Army for anything other than accident prevention purposes (for example,
Advocate Defense Counsel Office and request that the
disciplinary action against an individual), you should consult with your
Command Judge Advocate, U.S. Army Combat Readiness
local Judge Advocate Defense Counsel Office and request that the
Center, be notified at DSN 558 -2924 or commercial (334)
Command Judge Advocate, U.S. Army Combat Readiness Center, be
255-2924.
notified at DSN 558-2924 or commercial (334) 255-2924.
(7) The promise of confidentiality is available to you if you desire it. Do you
desire it?
15. AVAILABILITY OF PROMISE OF CONFIDENTIALITY FOR "LIMITED USE" REPORT OF INVESTIGATION
a. Pursuant to AR 385-10, 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 Name - do not sign)
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DA FORM 285-W, FEB 2009
APD AEM v1.00ES

Download DA Form 285-w Technical Report of U.S. Army Ground Accident - Summary of Witness Interview

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How to Fill out DA Form 285-W?

Procedural guidelines and additional information can be found in the DA PAM 385-40, released in March 2015. DD Form 285-W instructions are as follows:

  1. The name of the witness is entered in Block 1. Their general occupation and grade are provided in Blocks 2 and 3. Blocks 4, 5 and 6 require the witness's date of birth, address and telephone number.
  2. Block 7 is for the date the interview took place. Block 8 is for providing a brief summary of the witness's experience, expertise, and military background. The location of the witness at the time of the accident is specified in Block 9.
  3. Block 10 is for the grade and the last name of the person in charge of the interview. The name of only the lead interviewer is required if the witness was interviewed by different interviewers on separate occasions.
  4. Blocks 11a through 11c cover the promise of confidentiality. Block 11a is filled out if the promise of confidentiality was offered to the witness. If the witness requested confidentiality, the interviewer must complete Block 11b. Block 11c is for the signature of the interviewer and date of the interview.
  5. Block 12 is for the summary of the interview.
  6. The date of the accident is specified in Block 13. Block 14 contains the information regarding the promise of confidentiality that the interviewer has to read out to the witness.
  7. Block 15 reflects the availability of the promise of confidentiality for "limited use" reports of investigation.

DA 285-W Related Forms

  1. DA Form 285, Technical Report of U.S. Army Ground Accident is a form used for reporting any ground accidents that happen on U.S. Army grounds.
  2. DA Form 285-A, Technical Report of U.S. Army Ground Accident Index A is a form used for reporting Class A ground accidents in the U.S. Army.
  3. DA Form 285-AB, U.S. Army Abbreviated Ground Accident Report (AGAR) is a three-page form used for reporting ground accidents of classes C to E.
  4. DA Form 285-O, Technical Report of U.S. Army Ground Accident Statement of Reviewing Officials is a form filled out by the officials authorized to record and review the details of the accident.
  5. DA Form 285-B, Technical Report of U.S. Army Ground Accident Index B is a form used for making reports of Class B ground accidents occurred.
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