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DA Form 2823 (pdf)

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DA Form 2823, Sworn Statement


The DA Form 2823 is used for a variety of purposes from documenting informal counseling to recording evidence for an investigation. The guidance for filling out the form is in AR 15–6, Procedures for Investigating Officers and Boards of Officers. The section providing instruction for filling out the form is quoted below. Either a chronological narrative or the more formal question and answer format may be used. See examples below.


3–8. Witnesses

c. Taking testimony or statements.
(1) If a board is formal, or if the appointing authority has directed a verbatim record (see para 2–2), witnesses’ statements will be elicited by questions and answers. However, narrative testimony may be used.

(2) In informal proceedings, statements of witnesses may be obtained at informal sessions in which they first relate their knowledge and then summarize those statements in writing. A tape recorder may be used to facilitate later preparation of written statements, but the witness will be informed if one is used. The investigating officer or board will assist the witness in preparing a written statement to avoid inclusion of irrelevant material or the omission of important facts and circumstances. However, care must be taken to ensure that the statement is phrased in the words of the witness. The interviewer must scrupulously avoid coaching the witness or suggesting the existence or nonexistence of material facts. The witness may be asked to read, correct, and sign the final statement.

(3) Whether the witness swears to the statement is within the discretion of the investigating officer or president. If the statement is to be sworn, use of DA Form 2823 (Sworn Statement) is recommended. If the witness is unavailable or refuses to sign, the person who took the statement will note, over his or her own signature, the reasons the witness has not signed and will certify that the statement is an accurate summary of what the witness said.

(4) Whether the proceeding is formal or informal, to save time and resources, witnesses may be asked to confirm written sworn or unsworn statements that have first been made exhibits. The witnesses remain subject to questioning on the substance of such statements.

(5) Although the direct testimony of witnesses is preferable, the investigating officer or board may use any previous statements of a witness as evidence on factual issues, whether or not the following conditions exist:

(a) Proceedings are formal or informal.
(b) Witness is determined to be unavailable.
(c) Witness testifies.
(d) Prior statements were sworn or unsworn.
(e) Prior statements were oral or written.
(f) Prior statements were taken during the course of the investigation.


d. Discussion of evidence.
An investigating officer or board may direct witnesses who are subject to Army authority, and request other witnesses, not to discuss their statements or testimony with other witnesses or with persons who have no official interest in the proceedings until the investigation is complete. This precaution is appropriate to eliminate possible influence on the testimony of witnesses still to be heard. Witnesses may not be precluded from discussing any relevant matter with the recorder, a respondent, or counsel for a respondent.

e. Privacy Act statements.
(1) When required. A Privacy Act statement (AR 340–21) will be provided to a witness if the report of proceedings will be filed in a system of records from which it can be retrieved by reference to the name or other personal identifier of that witness. Unless otherwise informed by the appointing authority, an investigating officer or board may presume that the report of proceedings will be retrievable by the name of each person designated as a respondent, but that the report will not be retrievable by the name of any other witness. If any question arises as to the need for a Privacy Act statement, the investigating officer or board will consult the legal advisor, if any, or the servicing JA.

(2) Method of providing statement. Appendix B provides guidance for preparing Privacy Act statements. The statement may be written or oral, but it must be provided before taking the witness’s testimony or statement. A written statement will be attached to the report of proceedings as an enclosure. An oral statement will be noted in the report either as part of a verbatim transcript or as an enclosure, in the form of a certificate by the officer who provided the Privacy Act statement.

(3) Copy of the statement. Anyone to whom this requirement applies is entitled to a copy of the Privacy Act statement in a form suitable for retention. Providing a respondent a copy of the part of the report of proceedings (see para 5–10) that includes the statement satisfies this requirement. Any other witness who is provided a Privacy Act statement will, on request, be furnished a copy of the statement in a form suitable for retention.


Examples


DA Form 2823 Example








Since I have met J, I have felt there isn't an effective working relationship; not necessarily in reference to our occupational rapport, but personal issues he has deflected onto me. Within the time period I've been promoted into the Travel Assistant position, these are the issues I have encountered and endured:

Destruction of personal character

Harassment

Belittled, badgered, and harassed

Racial Discrimination (EEO)

Discrimination of medical disabilities (HIPPA, EEO)

Micro/ over management

Creation of a hostile working environment

Lacking communication

Baiting/ instigation of negative response(s)

Setting me up for failure, intentionally not providing any form of training or resources

Creating stipulations that exceed occupational scope

Unethical work practices in defiance with inspection (I.G)

Fear of reprisal and retaliation

Prior to taking this specific promotion, I was aware that J wasn't fond of me, based on snippety remarks such as white boy and I'm all about that black money, indicating that he was treating me a certain way because of my skin color. There has also been an obvious and noticeable drastic difference in the way J's rapport is with females, primarily African American females vice white males, which will be attested by many other witnesses throughout the Denver MEPS.

Within the first week, I was made aware that J conducted a meeting with two of his operational leads (Mr R and Ms B) for almost two hours and I was the subject matter referenced in this meeting. I felt that this meeting was unwarranted and offensive because it was in reference to creating a list of stipulations regarding my new job position (Based on personal preferences not related to positional job description)- premeditated harassment with the intent of intimidation in creating a hostile work environment.

The following day, I was called into J's office for the most unprofessional meeting I've ever participated in. J was upset that I provided accurate information regarding the DD Form 93 after I had noticed that he gave inaccurate information to our operational section. In retaliation, he made statements such as, Ask anyone in the MEPS about what they think about M and they will say M is lazy, M doesn't do shit, M doesn t do a fucking thing, followed by I WILL micromanage you- you are on a probationary period and if you mess up anything back there, you're fucking done! , (in reference to being fired). As I sat through this highly-offensive meeting of being belittled, he snidely told me in a condescending manner, you were only hired into this position because of your competition- if it were up to me, I would say they should've hired outside of the organization and I don t care about your personal issues or medical reasons for going on FMLA! You need to set that all aside and do your job. That stuff won't be getting in the way! This was the quotation which crossed the line from harassment to discrimination of a disability. I am an 80% Marine Corps Disabled Veteran and these remarks severely offended me because I felt that me being disabled and having to go on FMLA for medical reasons was disregarded and utilized as a tool for punishment by my supervisor.

A meeting on 08/12/2013) became even more hostile. I was told not to speak and he barked at me about what my agenda for the morning was. Once I began to respond to J to give clarification, he ssshhhhed me by rolling his eyes, yelling uhhh, NO, NO, NO. I was giving him clarification on ignorant assumptions, based on the fact that he had no idea what was actually going on. As his aggravation escalated he screamed SHUT UP and stop acting like a little kid. Before I could even get one single word out he showed me his teeth in an highly aggressive manner and kept growling at me shut your mouth and do what I said through his teeth. I have never seen such bizarre behavior in an office environment.

He has purposely made my job position increasingly difficult in various ways. Since I ve been in this position for three weeks, he has not provided me with one trickle of training. I asked him six times on my day 2 for training/ guidance and he said we're too busy for that, stop jumping the gun and I will tell you what to do when I need to. He has denied all of my potential access and resources to perform this job (i.e. refusal of forfeiture of office keys, government travel duty phone, travel safe, access to any travel-functional database, denial of passwords, Meal checks, critical P.O.Cs, and any I.G advised working essentials). The I.G indicated that meal checks were to be secured at the end of every working day and that each travel office had a safe located in the travel office. I brought this matter to his attention and he said you will not override me again and you aren't going to make any decision without me knowing so the answer is NO and don't ever do it again. He also has been intentionally waiting until the last minute before the shippers need to report to the airport to provide vital documents (i.e. Meal checks and itineraries) for the purpose of telling me that I was the reason that applicants shipping out missed their flights. This badgering was purposely performed to add unnecessary stress and harassment to my daily process. Once crunch time began, he would continuously antagonize me by saying, you see what you're doing, you are the reason why your shippers won't be getting on that plane, I hope you feel good about that and LET'S GO MR. M. This type of behavior is why I've had to exceed my working hours by 1-2 hours on several occasions. I was told in regard to lunch breaks Monday and Tuesday, you need to bring your lunch or not eat and you most likely will not get a lunch break and you will have to suck it up because you're the one who chose to apply for this job, however my acting travel assistant (Ms L) is able to come and go as she pleases without any form of communication. This is the only communication I have received. Lack of communication on J's part has set the Travel section back because he won't give me the information necessary to conduct my job, along with creating a highly-hostile working environment on a daily basis.

The ultimate impact of J's derogatory behavior has affected the Denver MEPS as a whole. Reason being, his refusal to effectively train and working vendettas resulted in the need to utilize the previous Travel Assistant for provided training. The problem is presented because she (Ms B) has been taken out of her critical position, due to J's incompetency.






On November 11th 2012, while assigned to Task Force X during training on the rappel tower, I saw a bird flying and thought I could fly too so I ignored cadre SFC Cowboy's instructions to not let go and to keep my hands on the rope. At this time the person on belay was scared that I was acting crazy and let go and ran away. I then proceeded to plummet about 50 feet in a downward direction at a high rate of speed. I hit the ground with my back making contact first and then my head bounced off the ground which was the cause of my dizziness and onset of pain to my back. After I hit the ground I was examined by the medic on duty SGT XXXXXX and cadre SSG XXXXXXX. I was sent to Carroll County Hospital for further evaluation to make sure I didn't fracture anything.

Upon returning to Camp Fretterd I reported to MAJ XXXXX and handed her my a Copy of my documents concerning this injury.






DA Form 2823: LTC Cook and a local automobile salesman engaged in a conversation through interpreter at about noon or after noon March 11, 2009. The conversation appeared cordial. US Soldiers from the 2d Brigade Combat Team, 1st Cavalry Division, 3d Battalion, 82d Field Artillery Regiment and Iraqi police patrolled what appeared to be a commercial truck yard called Al-Baraka, based on a sign observed while marching through the yard. The purpose of this patrol is to deny insurgents safe haven to construct improvised explosive devices. LTC Cook remained in a three-way conversation with the local business man and the interpreter, maintaining composure. The conversation ended with LTC Cook saying I ll let it be the Iraqi way and shaking the local business man s hand. Based on what I saw, the incident was cordial throughout and ended on a good note.///END OF STATEMENT///.






On 02 June 2013, around 0630 I was informed by SGT Lazoes to report to BDOC upon arrival. The Sergeant of the Guard stated that one of my soldiers had an ND around 0245hrs while pulling ECP strong point duty. After talking to the Sergeant of the Guard he mentioned that an CCIR was being filled out by him after that I asked is there any more information I need to know. His reply was no, that his chain of command will deal with it. After leaving BDOC around 0700 I called 198th commander to inform him of the situation. SPC Thomas made attempts to call Operations and other personnel prior to me calling the commander but to no success. No one answered at operations or their secondary numbers.






On 05 April 2013, I was given the room number where I was going to be residing for our stay on Camp Santiago. I proceded to take my bags to the room and this is when I met SGT R who was also going to be residing in the same room. As we introduced ourselves and I continued to unload my bags into the room we talked about several things. SGT R had mentioned to me that she was getting settled in and that I would be the only one staying in the room that nignt for she and her battle were going to be doing guard duty at the TOC, and that once she had unpacked her stuff, she was going to take a nap until it was time for her to report for duty.

I had left the room and went to make sure that I was no longer needed for any duty and had returned back to the room. This time when I had returned to the room I met the second soldier who was also assigned to reside in our room, SPC G, and as I did with SGT R we introduced ourselves and continued on with a conservation. At this time SGT R had mentioned that she was to attend an NCO meeting, to this she was waiting for further instructions. Myself and the two soliders continued to talk, I had left the two in the room and went to the TOC just to make sure I was not needed before I got settled in the room for the night. I had once again returned to the room with only SPC G still in the room who was preparing for duty for which she was going to be doing that night. We started talking again about several things and one of the subjects was about SGT R, she was waiting in the room before I had returned to the room the second time for further instructions as to when she needed to be at the NCO meeting. SPC G had informed me that there was an issue with SGT R and her NCO for whom SGT R was waiting for further information regarding the NCO meeting, they had called SGT R questioning her as to why she was not at the meeting. SPC G was informing me how SGT R and her NCO were not on the same level. For SGT R was instructed to stand fast until she had further notice about the meeting. But then her NCO called and questioned her as to why she was not at the meeting for it had started.

As I prepared myself to take a shower we continue to talk about SGT R and her issue, then I proceed with taking a shower. I am in the shower possibly twenty minutes and SPC G runs into the latrine and inform me that SGT R had returned to the room and was very upset and that she had packed all her stuff which were in the room when I had returned the last time. So in the mean time she must had packed all her stuff while I was in the shower. Because like I mentioned, SPC G ran into the latrine to get me and I told her to just give me a minute to get out the shower, well that did not happen because SPC G came running back into the latrine and told me that she needed me to come now. All I could do was grab my towel and I immediately wrapped myself in the towel and ran outside to talk with SGT R.

As I observed her behavior and looking into her car she had packed all her belongings and was sitting in her car. SGT R was crying franticly and was very upset about the situation. I was trying to calm her down and get her to come back into the room, she refused. I am standing between her and the door trying of calming her down. I asked her what was going on and she mentioned that things are not right and that she is being blamed for not following instrution. I asked her several questions as to what was the issue, who, what, why, and how. I asked her if she tried to communicate to the NCO as to what she needed to do and why she thought she was being blamed. I also asked her if there was someone else in her chain of command that she could talk with and she said no. I mentioned that if she felt like you she can't talk with them and she needed to work her issues out and needed to talk with someone that she can not do this alone. I asked her if she would like me to talk with anyone or even if me being present would help. She said: " no, nothing is going to help". I said: "maybe you can talk with your 1SG or somebody, you can not just leave and your not in the right state of mind to be driving."

As I continue to talk to her and, as I did not mention, SPC G was there too trying to talk with her also. And throughout our conversation SGT R was the whole time trying to text from her phone. I am asking her to call instead of texting and she just continued texting. I asked SPC G if she had the phone number of the NCO to call and she says yes and immediatley goes to retrieve her cell. As I continue to talk with SGT R she mentioned that she had an emergency and that she needed to leave. I asked her: "what is the emergency and had she informed her chain of command", she answered yes. I asked her again what is the emergency and once again no answer. with all this being said I informed her that she is not to leave and let me get her help. SGT R, still very upset. keeps yelling that she needs to close her door for privacy to call the NCO, throughout this time she continued to text. I am thinking okay I will allow you this time . Before we could even move out of the way fast enough she had drove off.






During August of 2011; Sgt Flournoy had received my Initial issue and issued the items to me. During said time no checks to see if all equipment issued was present or accounted for. During the particular timing of the said issue, I was rushed to sign my clothing record and return to my unit to continue mission. Later on as I went through the inventory of what was issued I had discovered that many items including all winter weather gear was missing. Requests were made to recieve the rest of my initial issued items; Sgt Flournoy had presisted that he would give me the rest in due time. Soon later he had ETS without returning the rest of my issue. During drill in NOV 2012 a request had been raised higher to SSG Reed concerning these issues that had been neglected by her predecesor. SSG Reed's advice was to wait untill the unit's showdown to collect a current list of all missing equipment and clothing.






The reason I wish to file an ETP is that on 18 December 2009, I enlisted in the New Mexico Army National Guard 17 December 2009. I received the first half of my 20,000 dollar bonus after completing AIT (10,000). The remainder of the bonus was to be paid on the third anniversary of my enlistment. The bonus should have been processed in December of 2012, and as of yet has not happened. My bonus was to include, 10,000 signing bonus, 5,000 off-peak bonus, and $5,000 quick ship bonus for a total of 20,000. I respectfully request that my Enlistment Contract be honored and my bonus processed.






On 142035 JUL 2005, during the Joint Operation Larry, Moe, and Curly, 2nd Marine Division, Route Clearance Patrol Army attachment was conditioning forward operations in Southern Baghdad. During this time one of the route clearance vehicles struck an improvised explosive device. The vehicle took damage to the front, with the engine and front axle breaking away from the cab of the vehicle, as it was designed to do. I approached the vehicle to check on the condition of everyone inside, due to negative communication after the blast. Everyone in the vehicle was okay except the dismount that was unconscious because of what appeared to be unsecure bottles of water. After securing the area we then began medical evacuation of the unconscious Soldier to the Green Zone.






On or about 081345(Z) AUG 2007, Spartan 4-2 was conducting route clearance on ROUTE GNAT in the Al Jabuor Providence in IRAQ. I was truck gunner for MRAP 7, when the Platoon Sergeant (SSG L.) called an all stop for interrogation. At that point she called the Buffalo Vehicle up to interrogate what she said to be a possible IED. Once the convoy was in position for security while interrogating, SSG L. turned the Warlock system off and proceeded to use her phone in order to call her husband. There had been rumors that she and her husband were having problems, witnessed by Soldiers overhearing phone conversations at the MWR. After the Buffalo Vehicle called all clear, everyone got back into configuration and continued mission. After about an hour SSG L. still had yet to turn the Warlock system back on.






While traveling from Vicenza, returning to Solbiate Olona on A-4 autostrada, in the far left lane, toward Milan we were side swiped by another vehicle (2) trying to dodge road debris. Vehicle (2) did not use any signal to indicate their intent to enter my lane. The weather was clear and the TMP was very visible with its headlights on. I tried to brake hard in order to prevent the accident however; vehicle (2) entered my lane too fast for me to react. We were impacted on the right front wheel causing it to go flat and pushed us into the far left lane guardrail. Vehicle (2) momentum then carried it across the front of our vehicle. The front of vehicle (2) then hit the guardrail, rolled back into the middle lane and came to a rest. NOTHING ELSE FOLLOWS






On or about 19 July 2011, I, Spc Pierre, was attached to C Co 1/67 AR. I left Afghanistan unexpectedly because I received a Red Cross call that required me to fly home immediately. So Spc Tran took me to the airport and when I arrived there I was told that I could not take my body armor and helmet with me on the flight to Kuwait. I had no choice but to leave it here in Afghanistan. I gave Spc Tran my body armor and my helmet and he took them back to Sgt Kates from C co 1/67 AR. On my return to duty, I did receive my body armor back but my helmet is missing.






On 23 March 2012 I was working as the Staff Duty NCO for Building 12001, 3rd MI BN, USAG Humphreys, APO AP 96271. At approximately 2030, while conducting routine security checks, I found Room 511 unsecure with music playing inside. I knocked on the door and announced my presence. Inside there was excess furniture and end tables stacked against one wall and 2 tables set up with four chairs around each. There were a deck of cards and a package of solo cups on the table. There were no clothes, or toiletries or anything that indicated that the room was being lived in. On the end tables there was an Ipod hooked up to speakers with music playing. Next to the speakers there was a Bottle of Crown Royale that appeared to be full. I checked inside the refrigerator and found 3 unopened bottles of clear liquors, and two full 6-packs of alcohol. I placed the unsecure alcohol in a trash can and secured it in the CQ Room. I logged the incident into the DA Form 1594 and attempted to contact 1SG Harris of B CO, 3rd MI BN. As I was logging the incident, I watched as SGT Hayes enter the building. While monitoring the cameras on the fifth floor I witnessed him enter room 511. I followed and entered the room and found SGT Hayes standing inside. I asked him about the alcohol and the room. He was cooperative and not confrontational. He admitted to me that the room was going to be used to play cards and have drinks with friends that were of legal drinking age. He told me that when he had left the building there had been someone in the room. I checked his ID to verify that he was SGT Cornelious Hayes of B CO, 3rd MI BN. He appeared to be sober so I explained to him that I would contact his 1SG and I returned the unopened alcohol to him. When I could not reach 1SG Harris, I contacted 1SG Cunningham of A CO, 3rd MI BN. At approximately 2115, 1SG Harris contacted me. I briefed him on the incident.






On or about 30 August and September 2010, I SSG Robert A.Green Jr, was assigned to the S4, HHC, 54th Engineer Battalion, Warner Barracks, Bamberg, Germany, APO AE, 09139. While assigned to HHC; I was assigned to the S4. the Battalalion was preparing for Deployment to Afghanistan. I can not verify if the TCAIMS was packed into the Sure Pack as indicated. I can only verify that I did see a TCAIMS in the Battalion Headquarters in Bamberg, in the S4 Office. END OF STATEMENT.






On or about 13 June 2011 in North Kaia, Kabul Afghanistan, myself and SPC Bacchus packed up items from SGT Campbell's wall locker which was located outside the barracks. Most of the items that was present in his wall locker was military gear. The wall locker was secured with a key lock before items was taken away from it. Once the custom inspector arrived I unsecured the wall locker with the key that came from SGT Campbell's plastic container that located inside the barracks area. Once the wall locker was unsecured myself and SPC Bacchus started moving the gear from the wall locker into the shipping container with the other gear that was being shipping back to Germany. SGT Campbell gear was label with his name once the inspector was done check his items. Once everyones equipment and baggage was pack inside the container it was secured and sealed.








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