NASA Headquarters' Directives
HQpr 8621.1 Effective Date: November 08, 2011 Expiration Date: June 08, 2019 Responsible Office: LA	Mishap Reporting, Investigating, and Recordkeeping Program and Plan

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Appendix J: Example - Statement of Witnesses

The purpose of this safety investigation is to determine the proximate cause(s) and root cause(s) of the mishap that occurred on _____________ and to develop recommendations toward the prevention of similar mishaps. It is not our purpose to place blame or to determine legal liability.

Your testimony is entirely voluntary, but we hope that you will assist the investigating authority to the maximum extent of your knowledge in this matter.

Your testimony will be documented and retained as part of the mishap report background files but will not be released with your name as part of the mishap report.

The investigating authority will make every effort to keep your testimony confidential and privileged to the greatest extent permitted by law. However, the ultimate decision as to whether your testimony may be released may reside with a court or administrative body outside NASA.

For the record, please state your full name, title, address, employer, and place of employment.