Statement Template!

[Vikeonabike]

Guys as promised:
Top one is a blank to be cut and pasted, use the next version as a reference: I have broken the second version down into paragraphs, there is no need to do this in an actual statement.

IPPEC method of statement-taking:
Introduction
People
Places
Event
Closure (to include victim personal statement)

I am making this statement about an incident that occurred on the (insert Date in full) 2010 on (road), (town), involving a (vehicle/person/object etc). In this account I will mention (number of people) people and a (vehicle, make, model, colour / object) with the index number (xxXXxxx). I have been cycling for X amount of years as (commuter/competitive) and consider myself to be a (experienced/inexperienced/ competent cyclist) I also hold a full car/motorcycle/HGVdriving licence and have done so for X amount of years. I consider myself to be an experienced/competent driver. The first person I will mention is (colour, sex, age, hair colour (length and style) facial features (eyes, facial hair, spots, etc), clothes, scars tattoos). This person I will refer to as “the driver” was driving a (make & model, colour, index) with (further distinguishing marks such as spoilers, body kit, loud exhaust, graphics, blacked out windows lowered suspension, dents, etc). The second person I will mention is (colour, sex, age, hair colour (length and style) facial features (eyes, facial hair, spots, etc), clothes, scars tattoos). This person I will refer to as: “The Passenger / Witness 1 etc”. This incident took place on (Road name / number) at the junction with (road name / number). I would describe this as road as (Description). A copy (of the video of the incident taken with my (name of camera)) / Photos of damage / injuries I exhibit as XXX y (your initials and number of exhibit). At the time of the incident the weather was (sunny (direction of sun may be important) / dark, overcast windy frosty icy snowy etc) I was wearing (clothing) and displaying (lights / reflectives etc).
At (time) on the (insert Date in full) 2010 I was cycling to/from (place) along the (road) in the direction of (place or compass direction) ….............................................
……………………………………………………………………………………………………………….Your text here. This should be a full description of actions, words and behaviours of the offender and yourself……………………………….
…………………………………………………………………………………………
At the time of the incident visibility was XXXXX, I was no more than XX metres/feet from the offender and there were XXX obstructions to my view. In total the incident lasted XX minutes/seconds. I know / do not know the person, I would / would not recognise them again. I am willing to attend court to give evidence if required.
This is the worst case of Driving / behaviour /abuse I have suffered/seen in X years of cycling. The incident has left me with x injuries that required x treatment (include Dr’s details /hospital details), damage to my bike to the value of £ and it will be some (length of time) before I can / feel ready to venture out on my bike again.

I have had the Victim Personal Statement Scheme explained to me and this is what I have to say on the matter.
Full explanation of how the incident has left you feeling…include any physiological / psychological injury and how you feel the matter should be dealt with in court / by police

 

[Vikeonabike]

Reference

Introduction:
I am making this statement about an incident that occurred on the First of April 2010 on Clarkson Road, Hamsterville, involving 2 males driving a Mean machine. In this account I will mention 2 people and a Mean machine in purple and black with the index number DD1. I have been cycling for 10 years as commuter and competitive rider and consider myself to be an experienced cyclist. I also hold a full car, motorcycle, and tracked driving licence and have done so for 20 years. I consider myself to be a competent driver.
People:
The first person I will mention is a white male, about 30 – 40 years of age and is about 6 foot tall, slim build. He has a long hooked nose, pointy chin and a very long black handlebar moustache. I could not see the colour of his hair as he was wearing a large Blue and red striped baseball cap with silver sunglasses on the peak. He was also wearing a long blue overcoat, black trousers and black shoes and red gauntlets. He spoke with an upper class English accent. This person I will refer to as “the driver” was driving a Mean Machine in purple with black trim, the index was DD1, with large yellow, roof spoiler, and yellow pointed nose fin. The vehicle had the number “00” on the door and a green circle at the front with a black “w” on it. The second person I will mention is a yellow male, I do not know how old, he was about 3 foot tall and of a rotund build. He was covered in yellow hair although his nose and ears were black, this male wore a red collar and spoke a foreign language that I did not understand. This person I will refer to as: “The Passenger”. The third person I wish to mention is a white female, around 5’7” tall, slim build with blonde hair in a pony tail and blue eyes, she was wearing a pink helmet, pink jacket and trousers and white boots. She was driving a Pink Compact Pussy Cat index PP1. This lady introduced herself to me as Penelope and spoke with a very high pitched American accent, possibly from the southern states of America. This person I will refer to as “PENELOPE”.
Places:
This incident took place on Clarkson Avenue at the junction with Hammond Crescent. I would describe this as road as wide road, straight road in a residential area with a 30mph speed restriction. The houses are set well back from the road and all have off street parking. The road has two lanes allowing vehicles to travel in opposite directions with plenty of room between them. There are several junctions along this road that lead off to more residential areas, one of which is Hammond Crescent. The road was quiet with very little traffic, the road was dry and clear or any obstructions. A copy of the video of the incident taken with my MOVIO 3000 I exhibit as SAG1. At the time of the incident the weather was Bright and clear, the sun was high in the sky, I was wearing a purple helmet, fluorescent pink cycling top and bright yellow shorts, my shoes where luminous green.
Event:
At 1300 hours on the Sunday the first of April 2010 I was cycling to Mayville along the Clarkson Road in westerly direction. I had been cycling for about 20 minutes, I had a light tail wind so I was riding at about 20 mph when I heard a car approaching from behind me, it appeared to be travelling at around the speed limit. I looked over my right shoulder and saw a Pink Compact Pussy Cat Car. As we were approaching Hammond Crescent the car had pulled in behind me and was indicating to turn left. Suddenly there was a loud roar and we were both overtaken by a Mean Machine at high speed. The Mean Machine turned left without warning, causing me too brake heavily, I hit the side of the Mean Machine and was catapulted over the bonnet, landing heavily on my right shoulder in the road. I heard a loud bang from behind me. As I sat up the Driver and Passenger got out of the Mean Machine and walked up to me and said “You TWAT why don’t you look where you are going, you ****ING cyclists shouldn’t be on the road, you don’t even pay road tax….look what you have doe to my car your ARSE HOLE. Next time I see you I am going to make sure you never get on a bike again..”, I was still very shaken and did not reply, the passenger then just giggled. The driver walked over to the other side of his car and then launched a tirade of abuse at Penelope calling her a “lipstick wearing hussy”. He has picked up my bike and thrown it down in front of his car and shouted “DRAT AND DOUBLE DRAT” the passenger giggled again. The both got into the Mean Machine and drove off over my bike. I could here the passenger giggling as they left the scene. Penelope then called the police and an ambulance. I was taken to Mayville hospital A&E where I was treated for a fractured collar bone and severe abrasions to my back.
Closure:
At the time of the incident visibility was excellent, I was no more than 1 metre from the offender and there were no obstructions to my view. In total the incident lasted 5minutes. I do not know the person, I would recognise them again. I am willing to attend court to give evidence if required.
This is the worst case of Driving and abuse I have suffered in 10 years of cycling. The incident has left me with a Fractured Collar bone that required treatment at Mayville hospital; where I was seen by Dr Foster. My bike is a total write off and will cost £3000 to replace. I will also be off work for 6 weeks and as a self employed basket weaver will loose in excess of £5000 income. It will be some at least 8 weeks before I feel ready to venture out on my bike again.

I have had the Victim Personal Statement Scheme explained to me and this is what I have to say on the matter.
The abuse I suffered from the driver of the vehicle has left me feeling extremely nervous and I feel even when fully recovered I may not be able to venture out on my bike again. I took his threats seriously and fully believe the next time he sees me on my bike he will run me off the road. The incident was caused by the reckless nature of the driver and he was not at all concerned for my health or my property, he appeared to blame the incident on the fact that I was a cyclist and should not be allowed on the road. His mentality shows that he should not be allowed to drive a motor vehicle on a road and that he has no thought for other road users. I would describe his behaviour as totally DASDARDLY

 

[Armegatron]

Thanks - much appreciated. I think I will be using this sooner than I would like

 

[Theseus]

Very useful, thank you.

Mods: can we make this a sticky?

 

[Origamist]

Vik, thanks for this template - it's v helpful.

 

[fimm]

I know this is a serious thread and a serious subject, but can I just say that the example statement is brilliant...

 

[benborp]

Even though I had to give a verbal statement, preparing a written one first from this template made a difficult situation much easier[sup]*[/sup]. Thanks Vikeonabike.


*Although it was quite amusing at times:

Me: Then he said "Do that a-*******-gain you ******* ****. Go on, you ******* *******. ******* *****."
PC: He said "******* do that again you ******* ****. Go on, you ******* *******. ******* ******."
Me: No. "Do that again you *******"- No, I mean, "Do that a-*******-gain you ******* ****. Go on, you ******* *******. ******* *****."
PC:"Do that a-*******-gain you ******* ****. Go on, you ******* *******. ******* *****."?
Me: Yes. Then he said ... etc

 

[decca234uk]

This is great, very useful. thanks for taking the time to do it and share it.

 

[Angelfishsolo]

I know this is a serious thread and a serious subject, but can I just say that the example statement is brilliant...

Seconded

 

[Angelfishsolo]

Even though I had to give a verbal statement, preparing a written one first from this template made a difficult situation much easier[sup]*[/sup]. Thanks Vikeonabike.


*Although it was quite amusing at times:

Me: Then he said "Do that a-*******-gain you ******* ****. Go on, you ******* *******. ******* *****."
PC: He said "******* do that again you ******* ****. Go on, you ******* *******. ******* ******."
Me: No. "Do that again you *******"- No, I mean, "Do that a-*******-gain you ******* ****. Go on, you ******* *******. ******* *****."
PC:"Do that a-*******-gain you ******* ****. Go on, you ******* *******. ******* *****."?
Me: Yes. Then he said ... etc

Now sadly that is all too familiar

I remember my first car crash (non fault as I was T-boned whilst driving through green lights). I screamed and shouted at the driver all manner of things. Then came the insurance form - "Please relate any conversation you had with the driver" - My reply "I lost my tempter and shouted at him but when I cooled down I apologised for my outburst" Had I written what was actually said (could U remember I would have been locked away )

 

[Matthew_T]

that is just incredible! So easy to put you own words into it. When I inevitably do have a collision with a vehicle, I will certainly use this.

What an absolute scorcher.

 

[cabern10]

Thanks for this....the template is so useful

 

[Rural halfwit]

I'd like to add to Vike's splendid effort..before the 'Victim personal statement' put in 'I support police action in this matter and I am willing to attend court if required. i also consent to details of any medical treatment in relation to this matter being used and disclosed in any court proceedings'

Vike will point out this is covered on the back of the MG11(The witness statement form) but always good I think to have it in the spiel too!

 

[Vikeonabike]

He's the one on the right, twylight.

Huh?

 

[Vikeonabike]

Can't believe I'm having to use my own statement template to write a statement!