Templates
General Accident Report Form

General Accident Report Form

Use the template to describe an accident report in detail. The first section of the template consists of a guide to what to do after an accident.

Use this template
or download pdf
General Accident Report Form

Use the template to describe an accident report in detail. The first section of the template consists of a guide to what to do after an accident.

Use this template
or download pdf

About the 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.

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.


Categories

  • Incident management templates
Preview of the template
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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This template, developed by Lumiform employees, serves as a starting point for businesses using the Lumiform platform and is intended as a hypothetical example only. It does not replace professional advice. Companies should consult qualified professionals to assess the suitability and legality of using this template in their specific workplace or jurisdiction. Lumiform is not liable for any errors or omissions in this template or for any actions taken based on its content.