Vehicle Accident / Incident Report Form

  • Remain calm
  • Call your supervisor or the office IMMEDIATELY from the site of the accident.
  • Complete this form as soon as possible, at the scene if possible, and turn in to your supervisor.
  • Your supervisor will take care of reporting to their insurance center.
  • If safe to leave vehicles in traffic, do not move vehicles until told to do so by Police.
  • Call police to investigate accident.




INSURED'S VEHICLE





OTHER VEHICLE INFORMATION

















WITNESSES






ACCIDENT