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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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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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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.