DA Form 2397-4 Technical Report of U.S. Army Aircraft Accident, Part V - Summary of Witness Interview

DA Form 2397-4 - also known as the "Technical Report Of U.s. Army Aircraft Accident, Part V - Summary Of Witness Interview" - is a United States Military form issued by the Department of the Army.

The form - often mistakenly referred to as the DD form 2397-4 - was last revised on February 1, 2009. Download an up-to-date fillable PDF version of the DA 2397-4 down below or look it up on the Army Publishing Directorate website.

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TECHNICAL REPORT OF U.S. ARMY AIRCRAFT ACCIDENT
REQUIREMENTS CONTROL SYMBOL
PART V - SUMMARY OF WITNESS INTERVIEW
CSOCS-309
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.
No (If Yes, read block 14a to the witness and complete
a. Was a promise of confidentiality offered to the witness?
Yes
block 15. If no, read block 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
a. Date (YYYYMMDD)
b. Time
c. Acft Serial No.
13. CASE NO.
DA FORM 2397-4, FEB 2009
PREVIOUS EDITION IS OBSOLETE.
PAGE 1 OF 2
APD LC v1.00
TECHNICAL REPORT OF U.S. ARMY AIRCRAFT ACCIDENT
REQUIREMENTS CONTROL SYMBOL
PART V - SUMMARY OF WITNESS INTERVIEW
CSOCS-309
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.
No (If Yes, read block 14a to the witness and complete
a. Was a promise of confidentiality offered to the witness?
Yes
block 15. If no, read block 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
a. Date (YYYYMMDD)
b. Time
c. Acft Serial No.
13. CASE NO.
DA FORM 2397-4, FEB 2009
PREVIOUS EDITION IS OBSOLETE.
PAGE 1 OF 2
APD LC v1.00
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 provisions of
(1) This accident investigation board has been convened under the provisions of
A Army Regulation 385-10 for the purpose of conducting a safety investi-
AR 385-10 for the purpose of conducting a safety investigation.
gation.
(2) This may be just one of a number of investigations being conducted regarding
(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
this accident; collateral or legal investigations may be ongoing as well. Those
investigations are entirely separate from a safety investigation and are also
investigations are entirely separate from a safety investigation and are also
required to inform you of their purpose and of 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
(3) This safety investigation is being conducted for accident prevention purposes
only. Within the military, pursuant to AR 385 -10, it cannot be used for any
only. Within the military, pursuant to AR 385-10, it cannot be used for any
other purpose, to include any future disciplinary actions against any
other purpose, to include any future disciplinary actions against any
individuals. Therefore, the interview you are being asked to provide will be
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.
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
(4) Nonconfidential witness interviews may be released to the public pursuant to
a summary of your interview, but the chain of command may only use the
a Freedom of Information Act request. If you wish to protect your interview
investigation report and the interviews for safety and accident prevention
from public release outside the military, then your interview must be pursuant
purposes. The interview summary may be released to the public pursuant to a
to a promise of confidentiality. Confidentiality means that your interview will
Freedom of Information Act request.
not be released to the public or outside DoD safety channels.
(5) If you ever have knowledge that your witness interview was used by the Army
(5) Whether your interview is confidential or not, the chain of command will review
for anything other than accident prevention purposes (for example,
the final accident report, which may include a summary of your interview, but
disciplinary action against an individual), you should consult with your local
the chain of command may only use the investigation report and the
Judge Advocate Defense Counsel Office and request that the Command
interviews for safety and accident prevention purposes.
Judge Advocate, U.S. Army Combat Readiness Center, be notified at DSN
558 -2924 or commercial (334) 255-2924.
(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 Combat Combat Readiness Center, be 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)
DA FORM 2397-4, FEB 2009
PAGE 2 OF 2
APD LC v1.00ES

Download DA Form 2397-4 Technical Report of U.S. Army Aircraft Accident, Part V - Summary of Witness Interview

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