VEHICLE ACCIDENT REPORT

AFTER AN ACCIDENT

Take steps to prevent further accidents
Remain calm: do not argue, blame, or accept blame
Provide immediate medical help; call 911 for emergency services
- Contact the police when damage exceeds $750, for any injury or death
Obtain and exchange personal information for this accident report including photos, and witness interviews.
Complete the Accident Report Form
- Determine if additional forms must be completed such as an Incident Report or a Hazard Notice.

DOWNLOAD | Diver Safety & Vehicle Use Program

DOWNLOAD | Vehicle Accident Report

ONLINE VEHICLE ACCIDENT REPORT FORM

* Indicates Required Field

EMPLOYEE DRIVER INFORMATION

Employee Driver Name*

Driver License # *

Phone #*

Department*

Supervisor's Name *

Type of VehiclePersonally-OwnedCompany-Owned

Make & Model *

License Plate # *

ACCIDENT DATE, TIME, PLACE

Date *

Time of Accident*

Location*

Photos Taken?YesNo

Videos Taken?YesNo

THOSE INVOLVED

Other Vehicle-Vehicle #2 Type

Vehicle #2 License Plate #, State

Vehicle #2 Driver Name

Vehicle #2 Driver License

Vehicle #2 Driver Address

Vehicle #2 Driver Phone

Vehicle #2 Insurance Company

Vehicle #2 Insurance Policy #

Other Vehicle-Vehicle #3 Type

Vehicle #3 License Plate #, State

Vehicle #3 Driver Name

Vehicle #3 Driver License

Vehicle #3 Driver Address

Vehicle #3 Driver Phone

Vehicle #3 Insurance Company

Vehicle #3 Insurance Policy #

Witness #1 Name

Witness #1 Phone

Witness #1 Address

Witness #2 Name

Witness #2 Phone

Witness #2 Address

Investigating Officer Name

Officer Badge #

Officer Phone

Officer Department

WHAT HAPPENED?

At what distance did you first notice the hazard? *

How fast were you going? *

Describe the damage to your vehicle

Describe the damage to other vehicles

Describe the damage to cargo

Describe the damage to property

Describe the accident including any factors that may have contributed (weather, road conditions, obstructions, etc.) *

ACCIDENT SCENE

Describe the accident scene, identifying where vehicles moved through the area and where they ended up, including the locations of any pedestrians, traffic signs or signals, your vehicles, other vehicles, or other hazards. *