Occupation: FIRE FIGHTER :~~:~:~n:i:n:~:,:.kn~ts.~...been extended by a week due to the numbers on...

12
WITNESS STATEMENT Criminal Procedure Rules, r 27. 2; Criminal Justice Act 1967, s. 9; Magistrates' Courts Act 1980, s.5B URN l .____._____,_ ___ ----'--__j Statement of: NIKI TYRONE MITCHELL Age if under 18: (if over 18 insert 'over 18') Occupation: FIRE FIGHTER This statement (consisting of page(s) each signed by me) is true to the best of my knowledge and belief and I make it knowing that, if it is tendered in evidence, I shall be liable to prosecution if I have wilfully stated in .. ..... .. u . u. u Uu u ·· · Date• 8.3.2019 This is my account of the fire at Grenfell Tower on Wednesday 14th June 2017. I will mention a number of people all of whom are in the London Fire Brigade (LFB ); Crew Manager (C/M) Jaydn Kearsarge. Fire Fighter (FF) Jessamine Bate. FF Chris Cheesman. FF Michael Pole. FF Chris Reynolds- Paddington -Turn Table Ladder driver. Watch Manager Louisa DeSilvo. W/M Brien O'Keeffe. Group Manager (G/M) Pat Goulbourne. I will mention Grenfell Tower and the internal layout of it up to, and including, around the 18th floor. I joined the London Fire Brigade (LFB) in May 2004 when I began my 16 week initial training at Southwark. The course was supposed to be 16 weeks but I remember that it may have been extended by a week due to the numbers on the course. During the course, we learnt about ladders, pumps, Breathing Apparatus (BA), fitness and Road Traffic Collisions (RTCs). In September 2004, I passed out of training and joined the red watch at Euston Fire Station. I have been posted there ever since, and so at the time of Grenfell I was based at Euston on Red watch as a competent Fire Fighter. When I was posted back in September 2004, I was classed as in development, which meant that I was still learning and needed to complete an evidence based book in order to become competent. I did that maybe 18 months later. MET00039859_ 0001

Transcript of Occupation: FIRE FIGHTER :~~:~:~n:i:n:~:,:.kn~ts.~...been extended by a week due to the numbers on...

Page 1: Occupation: FIRE FIGHTER :~~:~:~n:i:n:~:,:.kn~ts.~...been extended by a week due to the numbers on the course. During the course, we learnt about ladders, pumps, Breathing Apparatus

WITNESS STATEMENT

Criminal Procedure Rules, r 27. 2; Criminal Justice Act 1967, s. 9; Magistrates' Courts Act 1980, s.5B

URN l.____._____,_ ___ ----'--__j

Statement of: NIKI TYRONE MITCHELL

Age if under 18: (if over 18 insert 'over 18') Occupation: FIRE FIGHTER

This statement (consisting of page(s) each signed by me) is true to the best of my knowledge and belief and I make it knowing that, if it is tendered in evidence, I shall be liable to prosecution if I have wilfully stated in

:~~:~:~n:i:n:~:,: .kn~ts.~ .. ....... u . u. u Uu u ·· · Date• 8.3.2019

This is my account of the fire at Grenfell Tower on Wednesday 14th June 2017.

I will mention a number of people all of whom are in the London Fire Brigade (LFB );

• Crew Manager (C/M) Jaydn Kearsarge. • Fire Fighter (FF) Jessamine Bate. • FF Chris Cheesman. • FF Michael Pole. • FF Chris Reynolds- Paddington -Turn Table Ladder driver. • Watch Manager Louisa DeSilvo. • W/M Brien O'Keeffe. • Group Manager (G/M) Pat Goulbourne.

I will mention Grenfell Tower and the internal layout of it up to, and including, around the 18th floor.

I joined the London Fire Brigade (LFB) in May 2004 when I began my 16 week initial training at Southwark. The course was supposed to be 16 weeks but I remember that it may have been extended by a week due to the numbers on the course.

During the course, we learnt about ladders, pumps, Breathing Apparatus (BA), fitness and Road Traffic Collisions (RTCs).

In September 2004, I passed out of training and joined the red watch at Euston Fire Station. I have been posted there ever since, and so at the time of Grenfell I was based at Euston on Red watch as a competent Fire Fighter.

When I was posted back in September 2004, I was classed as in development, which meant that I was still learning and needed to complete an evidence based book in order to become competent. I did that maybe 18 months later.

M ET00039859 _ 0001

Page 2: Occupation: FIRE FIGHTER :~~:~:~n:i:n:~:,:.kn~ts.~...been extended by a week due to the numbers on the course. During the course, we learnt about ladders, pumps, Breathing Apparatus

Continuation of Statement of: Euston is a Fire Rescue Unit (FRU) station.

An FRU is a specialist vehicle which can deal with serious incidents. In 2007, I began a training course, which enabled me to work on the FRU.

The course was over a period and included learning about line rescue, serious RTCs and HAZMA T chemical.

In addition, I became qualified to wear Extended Duration Breathing Apparatus (EDBA).

EDBA differs to Standard Duration Breathing Apparatus (SDBA), as the cylinders are larger and are capable of providing more air in any one wear.

There is more air in the cylinders and, in the main, can be used by FRU crews. FRUs carry EDBA whereas the normal fire appliance doesn't.

You can tell the difference to look at as EDBA cylinders have orange covers, and SDBA have yellow ones.

In terms of my high rise training, Euston has a tower and we use it quite regularly. My old boss was quite into high rise and so we often practised on the tower.

I also remember using a disused hotel to practice, although I think that that exercise was probably after Grenfell.

I've attended a couple of high rise fires including ones in Stanhope Street, Adelaide Road and one at Shepherds Bush.

The one in Shepherds Bush was a couple of months before Grenfell, was a 10 pump and was across a few floors. lt went a couple of floors up, I think via some netting, the stuff they use for birds. From my experience, that's what leads fires to spread to different floors.

I don't think the building had cladding on the outside.

We regularly conduct 7(2)(0) visits to high rise buildings on our ground at Euston. Prior to the incident, I'd never been to Grenfell Tower it's not on our ground and I'd never heard of it.

But we regularly conduct visits to our own high rises to familiarise ourselves with the layout of the building, the number of residents, the positions of things like risers and who is in charge of the premises.

Once complete, a supervisor updates the system so that other crews can be made aware of issues through the MOT.

On Tuesday 131h June 2017, I began a night shift.

Signature Witnessed by Signature:. .... . ... .... .. .. . .. .. .. .. . .. . .. . .. . .. .. .. .. . .. . .. . .. .. .. .. . .. .. .. .. .. .. . .

M ET00039859 _ 0002

Page 3: Occupation: FIRE FIGHTER :~~:~:~n:i:n:~:,:.kn~ts.~...been extended by a week due to the numbers on the course. During the course, we learnt about ladders, pumps, Breathing Apparatus

Continuation of Statement of:

shown me a copy of the telemetry readings, taken from the Grenfell Public Enquiry website (PAF/26).

The timings that I mention are from that document. I don't know these timings to be accurate for sure as they are taken from the website.

I was riding not on the FRU, but on the pump ladder, which is a standard fire engine. We had a call sign of A231 .

I was riding with

• Crew Manager (C/M) Jaydn Kearsarge- In charge of the crew • Fire Fighter (FF) Jessamine Bate • FF Chris Cheesman • FF Michael Pole • Myself- Driver.

We started at 8.00pm and was due to finish at 9.30am the following day.

At the beginning of the evening, we had a few calls to attend. I remember someone being stuck in a toilet in either a Starbucks or Costa and a dog trapped in a park.

There may have also been a couple of automatic fire alarms that we went to.

On night duty, I never lay my bed until after midnight. I was just doing so when the station bells went down.

I don't know what the time was, but it must have been after midnight. The call is printed on a tele printer and I took the sheet and saw that it said we were being called to a 20 pump fire. That means that there are crews on scene who have asked that 20 fire appliances attend to deal with it. I saw that it said that there were persons reported which means that there are people inside the building.

That's a large fire, but in my experience, you often get to such incidents and find that they are under control and that you're there mainly on stand by.

So at that stage, I wasn't unduly worried about the call. I remember seeing the words "Grenfell Tower" and a post code.

I'm also a black cab driver and so know London well. I thought of Trellick Tower which is close by and I knew, but didn't know exactly where Grenfell was. I'd never heard of Grenfell Tower.

However, I knew the area and knew the route from Euston.

Signature Witnessed by Signature: ...... ... .. . .. ...... .. .... ............ ... ... ...... .. .. ...... .. . .... ..

M ET00039859 _ 0003

Page 4: Occupation: FIRE FIGHTER :~~:~:~n:i:n:~:,:.kn~ts.~...been extended by a week due to the numbers on the course. During the course, we learnt about ladders, pumps, Breathing Apparatus

Continuation of Statement of: All of my crew were at the appliance within seconds and I drove out on blue lights and two tones. Almost straight away, I heard on the radio that the 20 pumps had been increased to 25. I also heard that there were Fire Survival Guidance Calls (FSGs).

FSGs are when members of the public are trapped in a building through smoke or fire and are given advice from our control room operators.

I turned onto the Harrow Road, left into Ladbrook Grove and right into Bassett Road. The route on the way to the scene was clear.

Once in a road off of Bassett Road, manoeuvring the appliance became difficult due to the parked cars on either side of the road. lt was taking too long to get down the road, I knew that we were quite close and we decided to park the appliance and walk the rest of the way.

I was driving so I don't know if there was any information on the MDT specifically about Grenfell.

I've been shown a map of the area by the police but it doesn't help me identify where we parked. I just don't know where we parked.

Once I had parked up, we all put our BA sets on, including C/M Kearsarge. That was quite unusual as the C/M wouldn't normally do so.

I've been shown PAF/26 which is a print out of my telemetry taken from the public inquiry website by Mr Fuller, the investigator who has taken this statement.

From that document, I can say that I unplugged my BA set from the appliance at 01.46.55.

There were loads of members of the public milling around but we didn't speak to any of them.

I hadn't seen any of the building throughout the journey. We walked towards the tower and once we were a few yards away from it, I took my first look at it.

There were flames halfway up the building and the section that was alight was fully burning.

There was burning debris falling from the tower and crashing on the ground and I could hear glass smashing all around us. The debris was of all different sizes.

I saw a Turntable Ladder which was re positioning itself, try to put water onto the tower. I think the driver was FF Chris Reynolds from Paddington. I also remember seeing some other covering jets being put onto the building.

An officer told us to go back to our machine and collect breaking in gear, hose and branches which we did. The 5 of us went to do so but at some stage, I'm not sure when, C/M Kearsarge left us for another task.

M ET00039859 _ 0004

Page 5: Occupation: FIRE FIGHTER :~~:~:~n:i:n:~:,:.kn~ts.~...been extended by a week due to the numbers on the course. During the course, we learnt about ladders, pumps, Breathing Apparatus

Continuation of Statement of:

The four of us went back to the tower with the equipment that we had fetched from our machine and found ourselves at the main entrance to the tower. lt was clear that we were going to be deployed into the tower and Jess had just come back to work from -leave.

I remember thinking that the fire was such that Fire Fighters were going to die tonight and saying to FF Bate that she didn't have to go inside but she said to me that she wanted to and was fine with it.

There was a system where they were letting fire fighters in a bit at a time but there came a stage that I found myself with FF Pole with the two of us separated from FF Bate and FF Cheesman.

We had wanted to stay as a team but FF Pole and myself were then sent into the tower. We went through the main door into the ground floor area.

Once inside, I saw loads of people and strangely, I saw a man, not wearing fire gear, with some kind of sledgehammer. I thought to myself "who the hell is this?" But that was the last I saw of him.

A bridgehead is an area, safe from fire, where officers control the entry of Fire Fighters using an electronic Control Board (ECB).

The bridgehead, at that stage wasn't on the ground floor which although had water everywhere, had breathable air. FF Pole and myself walked up some stairs onto a mezzanine area to a floor where I saw W/M Louisa DeSilvo.

I knew Louisa as she had been at Euston Station on the red watch and saw that she was with W/M Brian O'Keeffe and FF De St Aubin.

They were running the bridgehead with ECBs, along with a G/M called Pat Goulbourne.

FF Bate and FF Cheesman then appeared. I don't know where they had been but we were now back together as a 4.

There were FFs everywhere but their entry up into the building was being controlled here.

Whilst we waited, I think there was a Fire Fighter emergency where a FF had gone missing. That was quickly resolved and he was found. There were people being brought out by fire fighters suffering from smoke inhalation.

I listened to other FFs being sent to different places in the tower and there then came a bit of confusion where we were told a number of different flats that we were being sent to. The flat numbers changed until we were finally told to go to either the 23rd or 24th floor. I can't remember exactly which one it was and I can't remember the door number that we were

M ET00039859 _ 0005

Page 6: Occupation: FIRE FIGHTER :~~:~:~n:i:n:~:,:.kn~ts.~...been extended by a week due to the numbers on the course. During the course, we learnt about ladders, pumps, Breathing Apparatus

Continuation of Statement of:

We were told that we were to go up and rescue people on that floor.

lt was really busy on the bridgehead and I remember thinking that I wouldn't have wanted to be in her role as it was so stressful and hectic.

We were told that the four of us were to go to the 23rd or 24th floor.

I remember that entry control staff were using a wall to write information on.

I've been shown a photo (PAF/25). That looks like the wall that was being used.

When I first spoke about the incident to the police, I thought that the bridgehead was on the 2nd floor. The photo appears to have been taken on the third floor, so I guess that we may have been on that third floor.

If you look at the photo you can see that Euston is written twice, once at the top, next to floor 23 and once near the bottom right.

That makes sense and I guess was written by someone on the Bridgehead to record where we had been sent.

I remember thinking that we'd struggle to get to such a height wearing SDBA. I can't remember seeing any EDBA wearers waiting to go in and so I assume that there weren't any to deploy at that stage.

From PAF/26,1 handed my tally in at 02.52.34 and the four of us started to climb the stairs, under air.

I led the team and quickly found hose lying on the stairwell which was dark and narrow. I could hear the noise from other crews but couldn't make out what was being said.

The conditions changed as we went up. There would be places where it became hot and smoky but then cleared to a cooler, clearer environment.

I quickly became tired. My mouth was getting dry, and I felt like taking my mask off. I've never had that before.

As we went up, I tried to count the floors to keep track on what level we were at. I only remember one floor being marked and that was the 7th which had been written on in china graph.

There came a point when I was become an ineffective leader of the group. I was carrying hose, was becoming anxious and so stopped counting the floors as it was making me feel worse.

Because of this, I didn't feel that I was performing well enough and so asked one of the others to go ahead.

M ET00039859 _ 0006

Page 7: Occupation: FIRE FIGHTER :~~:~:~n:i:n:~:,:.kn~ts.~...been extended by a week due to the numbers on the course. During the course, we learnt about ladders, pumps, Breathing Apparatus

Continuation of Statement of: The hose was heavy and I thought that there must be hose already up above and so I left the hose and found myself either third in line or at the back.

When we got to the 10-11 or 12th floor, we came across another FF crew who said that they needed help with a child that they were carrying.

From the start, I had been concerned over FF Bate and saw this as an opportunity for her to go back down.

I asked her to help the crew with the child which she did and she left us, to make the rescue and went down. I don't know who had hold of the infant but the crew took him/her down.

That left the three of us.

We carried on up and there came a stage when we stopped to check our air gauges. Although we didn't know for sure what floor we were on, it was clear that we had enough air to get to the top of the building but wouldn't have enough to come back down.

This didn't surprise me as we had been working hard wearing SDBA sets. I thought when we started that to get to the top of the building in SDBA was a big ask.

We made the decision to stop there, search the floor that we were on and come back down.

At the time I didn't know exactly what floor we were now on. I now think that we were on the 181h. I have explained the reason for this in the last paragraph of this statement.

I opened the door which separated the staircase and the lobby of the floor. As I did, I was suddenly grabbed by a man, a member of the public.

He was speaking to me, I think in a foreign language. I asked him how many of them there were and he replied "7".

I didn't ask him the make up of the 7, whether they were men, women or children.

I realised that there were seven people to be rescued and the three of us. lt was dark, smoky but on that floor, not too hot. Because it was dark and smoky, we couldn't leave them up there and needed to try to rescue them.

I made the decision that we would take the seven down using a human chain. One of us Fire Fighters at the front, one in the middle and one at the back.

I think they came from a flat and there was a mixture of men and women. I don't remember seeing any children at any stage.

Signature Witnessed by Signature: ...................................................... . . . . . . . .

M ET00039859 _ 0007

Page 8: Occupation: FIRE FIGHTER :~~:~:~n:i:n:~:,:.kn~ts.~...been extended by a week due to the numbers on the course. During the course, we learnt about ladders, pumps, Breathing Apparatus

Continuation of Statement of: At no point did any of us go into any of the flats and I was never told how the group had come to be together.

We started the rescue with me in the middle of the chain and FF Pole at the front but I quickly realised that we had gone the wrong way.

We turned round which meant that FF Cheesman was now at the front, me in the middle and FF Pole at the back.

I had a male holding onto me on my right. I think it was the original man who had first grabbed me and he held tightly onto me. I don't think he let me go from the moment he first grabbed me.

There was a woman, I think dressed in white, behind me who held onto my shoulder straps.

The man was so anxious that as he held onto my right arm, he began to bite into it, through my tunic, with his teeth. He kept talking and praying, saying that we were all going to die.

This was wasting valuable energy and was making him breathe in thick black smoke more than he needed to.

I had to become firm with him and instructed him to stop talking, and to concentrate on getting down the stairs. I reassured him by telling him that we'd be OK, but deep down I didn't think we would because of the smoke.

We marched down the stairs in pitch black, with smoke everywhere. I still had the man but at some stage the woman came detached from me.

The journey down seemed like forever but probably took 7 - 10 minutes. I remember seeing floor number 7, where it had been written previously and remember thinking that we weren't going to make it.

We didn't see any other crews until there came a point where I saw some light and heard other crews. A Station Manager with white cropped hair appeared, I don't know his name, who came to our help and took some casualties from us. I don't know what floor we were on at this stage, but they weren't under air so it must have been on one of the lower floors.

The casualties were taken from us but then both FF Cheesman and myself realised that FF Pole wasn't with us. I can't remember if our BA whistles were going off - I think they were -but at this stage, I remember hearing some other whistles which indicate an evacuation of the building.

The other casualties that we were escorting down may have gone past me, I can't remember.

We couldn't leave him and so the two of us began to walk back up the stairs, back into danger. I remember some other Station Managers telling us to leave but we told them that we weren't going to I e FF Pole whils ·11 missing.

Signature Witnessed by Signature:..... . ....................... . ............................ . . .....

M ET00039859 _ 0008

Page 9: Occupation: FIRE FIGHTER :~~:~:~n:i:n:~:,:.kn~ts.~...been extended by a week due to the numbers on the course. During the course, we learnt about ladders, pumps, Breathing Apparatus

Continuation of Statement of:

The staircase had a number of turns between each floor and we climbed a few of them, shouting for FF Pole. We went up maybe 2 floors, still not knowing where he was. He could have been close to us, or he could still be towards the top of the tower.

Suddenly we found him, grabbed him and took him quickly down. I can't remember if he was with any casualties.

Unbeknown to us, whilst in the tower, the bridgehead had moved from the 3rct to the ground floor.

I saw Louisa and took of my mask. There, lying on the floor, I saw the man who I had rescued who had been biting my arm. He grabbed my ankle and started to thank me.

That's the only person from the group that I saw. I hadn't seen any children on the group and I didn't see any of the women afterwards.

At this stage, I didn't know where FF Bate was and people started taking my kit of which was dropped to the floor. I don't know what happened to it but I was completely exhausted and needed to get out of the tower.

I managed to speak to Louisa and told her that we hadn't got to the 23rct floor but had got fairly high up and rescued a family of 7. She was really concerned about our welfare and the condition that we were in. I also told her that FF Bate had left before us and that I didn't know where she was.

I was concerned about FF Bate and told her how we had become separated .

PAF/28 shows that I took my tally from the board at 03.17.17. The telemetry shows that I started with an initial pressure of 284.69 and left with 90.33.

We left the tower using a different exit point to the one we had entered through, escorted by police with riot shields above our heads, protecting us from the falling debris.

I remember seeing the other crew from Euston who wearing EDBA and were about to be deployed and telling them to be careful, it's serious in there.

Once outside, there was a grass area on which we sat for a while. There were members of the public who had become agitated and who were shouting at us. I guess they saw us sitting down and didn't realise that my crew had just been in the tower and the stress that we had just been under.

I looked at the tower, which was now fully alight. lt had changed since I first went in as initially, the flames were half way up. Now the whole tower was alight, right to the top.

There were now residents at the windows, screaming and calling from help who I hadn't seen when I first went in.

Signature Witnessed by Signature: ....... .... . ... .... .. .. ........................................ .. .. .

M ET00039859 _ 0009

Page 10: Occupation: FIRE FIGHTER :~~:~:~n:i:n:~:,:.kn~ts.~...been extended by a week due to the numbers on the course. During the course, we learnt about ladders, pumps, Breathing Apparatus

Continuation of Statement of: There was a triage area where they were bringing out bodies and casualties. The ambulance staff were dealing with them and I remember seeing one particular casualty who looked deceased.

After a while, I was sent to a Fire Rescue Unit to get some EDBA cylinders. But the machines were locked. Whilst there, I spoke to a resident who said that his dad was still inside with his two dogs. He gave me his dad's flat number so I went back and gave the flat number to a crew manager. I assumed that the must have already had the number, but I gave it just to make sure.

From then on, I did bits and pieces like holding shields for people going in and out of the building.

There were loads of fire fighters about and although I wanted to go back in, I knew that there were crews that were fresh and that I wouldn't be doing so.

I remember AC Andy Roe giving us a rallying talk, telling us well done and the situation. I remember the commissioner speaking to us, asking us if we were OK. I thought that unusual and uplifting for us as the last commissioner would not have been on the fire ground.

We met up with both C/M Kearsarge and FF Bate who was safe.

My crew, each of the ones who had arrived together, were relieved and went to Paddington Fire Station to complete some notes of what had happened. I produce those notes as exhibit NTM/1.

From there, we went back to Euston, arriving at around midday. I've not been back to the tower since.

At the time I didn't know what floor we had been on when we rescued the 7 people. We'd gone up quite a few floors since the 7th but I now, looking back, I think we were on the 18th.

The reason that I think this now is that a few days after the incident, I spoke to a Fire Fighter from West Hampstead called Brian Flanagan. When I spoke to him and told him what we had done, he made me believe that we had been on the 18th floor.

When I described the family and that there were 7 of them, he said that he had already been up there to the 181h floor and told a Somalian family of 7 to stay in their flat. That's what makes me now believe that we were on the 18th floor when we first came across the family of 7. Although I don't know for sure, the 18th seems about right.

I've been asked if there are both children and adults in a group requiring a rescue, whether I'm aware of any policy directing fire fighters to prioritise children.

I'm not aware of any such policy.

Witness Signature: .. ~ ... ..... .... . .

Signature Witnessed by Signature: ........ .......... .... .. ... ..................... ............. ;,;j •• ._....~ ..

M ET00039859 _ 001 0

Page 11: Occupation: FIRE FIGHTER :~~:~:~n:i:n:~:,:.kn~ts.~...been extended by a week due to the numbers on the course. During the course, we learnt about ladders, pumps, Breathing Apparatus

Continuation of Statement of: I've also been asked if I was aware of any fire fighting plan when compartmentation fails. I'm not aware of any such plan. Prior to Grenfell, I'd not been aware of the risk of flammable cladding, I've only been made aware of it since.

Looking back, I think if the stay put policy had been abandoned earlier, we may have more deaths. The staircase was small and there would have been carnage on them.

I've never experienced a fire like Grenfell and I've never had to rescue 7 people all at the same time. I've never had to travel that distance and been that far away from safety in SDBA before.

I've been asked if I think anything could have been done different. Looking back, it would have made more sense to send EDBA to the upper floors and use SDBA for the lower floors.

The man that grabbed me and that I took down was either Somali or Eritrean in appearance. He was maybe in his 40s, slim and around 5'9" tall.

I produce the notes that I made at Paddington as exhibit NTM/1

Page 11 of 11

MET00039859_0011

Page 12: Occupation: FIRE FIGHTER :~~:~:~n:i:n:~:,:.kn~ts.~...been extended by a week due to the numbers on the course. During the course, we learnt about ladders, pumps, Breathing Apparatus

RESTH.I( 'J fl) (n ht·n rompll'tt)

Witness contact details •

MGll Page 3 of3

Home address: ~.N hO.....c ~ ~ 0 ~ 0 0 0 00 00 0 0 0 O O OO oo O O o o 0 0 0 0 O 0 oOO 0 O O OO O 00 0 0 "' Oo 0 0 0 o o oo 0 0 0 o• 0 0 00 0 oo 0 0 ••O ooo O Oo O O o o 0 00 0 0 0 0 0 oooooo o o o o o oo o o o oo oo o oo o o oO OOoo I 00 0 0 0 0 0 o oo 0 0 o 0 o oo o oo o oo 0 0 o 0 o o 0 o• oo o 0 .. O O

0 0 0 0 0 00 000 O O o

0 O

0 0 oO

0 0 0 0 00 0

........ .. ...... ..... .................. .... ...................... ............. ...................... ........ ...... .......... ........... .... ................ Postcode: ' ".?'"'''""'"'"'" ' '"""

Home telephone

Mobile/pager number

telephone number ......... ........ ............................................. address: ······················ ··· ····················································

Preferred means of contact: .. ..................................................................... ..

@V~ (delete as applicable) Date and place of birth:

Former name: ............................................... Ethnicity Code (16+1):

Dates of witness non-availability I o 0 0 0 0 0 000 00 0 I 0 0 100 0 0 o oO o• 0 o o oo oo I 0 o 0 ooo o o o 00 o o 0 o o 0 0 oo o oooooO I 0 0 000 I 0 oo 0 0~ 0 0 00 0 ooo 0 •• o o o o o 0 o 0 0 0 Oo o. o 0 0 0 0 o Oooo oo ~- · oo 0 0 0 0 0 o•o O O O O •• O 00 0 O 0

OO OO 0 0 0 0 0 000 0

ooo 0 0

............................................................................. ........... ............................. ······ ................................................ ~ -· .............. ............................. . Witness care

a) Is the witness willing and likely to attend court~~ If 'No', include reason(s) on MG6 . . b) What can be done to ensure attendance?

c) Does the witness require a Special Measures Assessment as a vulnerable or intimidated witness? Yes /No. lf'Yes' submit MG2 with file.

d) Does the witness have any specific care needs? Yes I No. If 'Yes' what are they? (Disability, healthcare, childcare, transport,, language difficulties, visually impaired, restricted mobility or other concerns?) '

Witness Consent (for witness completion) a) The criminal justice process and Victim Personal Statement scheme (victims only) has

been explained to me

b) I have been given the Victim Personal Statement leaflet

c) I have been given the leaflet 'Giving a witness statement to police- what happens next?'

d)

e)

t)

I consent to police having access to my medical record(s) in relation to this matter: (obtained in accordance with local prnctice)

I consent to my medical record in relation to this matter being disclosed to the defence:

I consent to the statement being disclosed for the purposes of civil proceedings e.g. child care proceedings, CICA

Yes

Yes

Yes

Yes

Yes

Yes

D D D D D D

No

No

No

No oN/A

No oN/A

No~

The information recorded above will be disclosed to the Witness Service so they can offer ll. help and support, unless you ask them not to. Tick this box to~ their services: u....,.v--

g)

Signature of witness: < ........ Print name:~.~-~:::~ ..... ~ .. f.!.0.~ .... Signature of parent/guardian/appropriate adult: ................. .. . .. ............. ......... .. .. ..... Print name: .................. .... ........ ......................... Address and tele hone number if different from above: .................................................................................................... .....................

Statement taken by (print name): ~.~ .. ~.':::~ ..... .......... ...... . StationP~ ....... ~C..~~~~. '6~( 0 .............. .......... ~ ............. ...... f..p. .. -: ..... .. ..... ............ ................................ .......... ... ............. ..... . Time and place statement taken:

• I -- , . RFSTIHCITD (\\ hl'n compktl')

M ET00039859 _ 0012