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Vehicle accident report form

Keep one in every glove box. It lists what to write down at the scene, so nothing is missing when the claim is filed.

Make it yours, then print

What you type shows on the form below as you type. Nothing is uploaded or saved on our side.

Vehicle accident report

Date Unit

At the sceneTick: Done

  • Everyone safe; 911 called if anyone is hurt
  • Hazards on, triangles out
  • Photos: all vehicles, plates, the scene
  • Photo of other driver's license and insurance card
  • Police called / report number taken
  • Supervisor told

When and where

Time
Street / intersection
City, state
Weather / road conditions
Speed at the time

Our vehicle and driver

Driver
Vehicle / plate
Damage to our vehicle
Injuries in our vehicle

Other vehicle and driver

Name
Phone
Address
Driver license no.
Year / make / model
Plate and state
Insurance company
Policy no.
Owner (if not driver)
Damage / injuries

Police and witnesses

Police department
Report no.
Officer name / badge
Citation issued?
Witness 1 name and phone
Witness 2 name and phone

What happened (and a sketch on the back)

Driver signatureDate
Received by (supervisor)Date
Free form from gpsleaders.com

Tips for using it

  • Make sure everyone is safe and call for help first; the form can wait.
  • Take photos of all vehicles, plates, the scene and the other driver's license and insurance card.
  • Write down facts only. Do not argue fault at the scene.
  • Report to your supervisor and insurer as soon as you can, with this sheet.

Questions

What information should I collect after an accident?
The other driver's name, contact, license, plate and insurance; the time and place; police report number; witnesses; and photos. The form has a line for each.
Is this a police report?
No. It is your company's internal record. The police report is separate; write its number on this form.