How To Write A Statement Letter For A Work Incident . Let him know about the request and show him the document you received or tell him the company refused to put the request in writing. Dear (name of supervisor) : 12+ Official Statement Letter Format Examples PDF, DOC Examples from www.examples.com Write the incident report in complete sentences and use simple language. Explain the situation and show him a draft statement that you plan to submit. Record an account of any damage to equipment, materials, etc that was affected by the incident.