Page 198 - 4. 2014 2nd half New 26-05-21 No Table

Work telephone number
Mobile/Pager number
Email address:
Preferred means of contact-

Male / Female (delete as
applicable)
Date and place of birth:
Former name:
Ethnicity Code (16+1)
Religion/belief:
Dates of witness non-availability
Witness care

a) Is the witness willing and likely to attend court? Yes
/ No. 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. If ‘Yes’ submit MG2 with file.
d) Does the witness have any specific care needs? Yes /
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 Yes No N/a
process and Victim
Personal Statement
scheme (victims
only) has been
explained to me
b) I have been given Yes No N/a
the Victim Personal
Statement leaflet
c) 1 have been given Yes No N/a
the leaflet ‘Giving a
witness statement to
police — what
happens next?’
d) I consent to police Yes No N/a
having access to my
medical record(s) in
relation to this
matter:
(obtained in
accordance with
local practice)