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General Accident Report Form


Need a pre-made form to to help you write a detailed description of a vehicle collision? This template provides instructions on what to do in case of a car accident in addition to fields where you can fill out essential information.


Include driver information such as license numbers, license plates, and the car's makes and models. Document the police report number so you can have access to the official report later for insurance purposes. Lastly, describe how the accident occurred, including directions, road conditions, speed limit, location, etc.


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General Accident Report Form

Audit

Vehicle Accident Report Form

If you are involved in an accident:
* First, assess the condition of any passengers in your vehicle.
* If there are injuries, request medical assistance immediately.
* Call the police- we want an accident report completed by the police no matter how minor the incident.
* Remove the vehicle from the street if leaving it there creates a safety hazard, but do not leave the scene of the accident until released by the police officer.
* Contact immediate supervisor/fleet/safety administrator.
* Complete the vehicle accident report at the scene if able to or as soon as possible.
* You may provide the other party involved in the accident with your name, the company name, the company's phone number, vehicle identification, and insurance information, BUT DO NOT ACCEPT RESPONSIBILITY OR ADMIT LIABILITY. This is a "legal call" that should be made by our insurance company's claims department.

Vehicle Accident Report

Office use only (Claim#)
Employee's Name
D.O.B.
Date of Occurrence
Time of Accident
Chose one
Drivers License Number
State
Location of Occurrence: Street/Hwy
City
State
License plate # and State
Vin#
Type of Vehicle: Year, Make, Model, Color.
What are the damages to our vehicle.
Passengers
How Many?
Injuries
Vehicle Owned by:
Witnesses
If yes please provide name and phone number

POLICE MOST BE CALLED

Police Report # or Case #
Where the report can be obtained and when.
Name of responding Police Officer
Was it local police, County, or State Highway Dept.
Was an ambulance called?
If yes what was the name

Other Vehicle

Driver's Name
Is this person the owner of the vehicle?
If, not owners name and relationship to the driver.
Address, city and state.
Phone number including area code.
Insurance Company
Policy#
Insurance Company phone #
Drivers License Number and State
Vehicle license plate number and state
Type of vehicle, year,make, model and color
Description of Damage
Passengers
If yes, how many?
Injuries?
Passengers Names

Personal Injuries

Name
Address
Description of Injury
Treated at
Name
Address
Description of Injury
Treated at
Name
Address
Description of Injury
Treated at
Name
Address
Description of Injury
Treated at
Name
Address
Description of Injury
Treated at

Property Damage

Owner
Address
Description of Damage

Accident Information

Select date
Location (street, highway, city, state, etc.)
Weather
Area
Road
Condition
Direction (YOU)
Direction (OTHER)
Speed: posted and actual (YOU)
Speed: posted and actual (OTHER)
If Intersection
Brief description of the accident

Accident Diagram

Draw a detailed sketch of the accident. Show directions and position of vehicles involved. Show number of lanes, traffic control, pedestrians, etc. Use these symbols. Your Vehicle (A), Other Vehicle(s) (1B, 2-B), Direction (N, S, E or W), Stop Sign (S), Caution Signal (C), Yield (Y), Pedestrian (P), Railroad (RR)
Diagram

Internal Accident Analysis

Was this accident avoidable?
What action should have been taken to avoid the accident?
What training needs to happen NOW to change driver attitudes/behaviors so that our company avoids this type of accident in the future?
Add signature
Select date
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Please note that this checklist template is a hypothetical appuses-hero example and provides only standard information. The template does not aim to replace, among other things, workplace, health and safety advice, medical advice, diagnosis or treatment, or any other applicable law. You should seek your professional advice to determine whether the use of such a checklist is appropriate in your workplace or jurisdiction.

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