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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 general accident report form provides instructions on what to do in case of a car accident in addition to fields where you can fill out essential information.

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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)
annotation!!!
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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This post is also available in: Español

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How to Use a General Accident Report Form for Effective Incident Reporting


Accidents can happen in any workplace, and it’s crucial to have a proper reporting system in place to ensure that incidents are recorded and addressed. A general accident report form is an essential tool for incident reporting that helps organizations document accidents and take necessary corrective actions to prevent future incidents. The form usually includes information such as the date and time of the incident, the location, the people involved, and the cause of the accident.


The general accident report form is an easy-to-use and effective way to report accidents and investigate their root causes, enabling organizations to improve safety and prevent similar accidents from occurring in the future. By using this form, organizations can promote a safety culture where employees feel empowered to report incidents without fear of reprisal, and everyone works together to ensure a safe work environment.


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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