WHEN AN ACCIDENT HAPPENS:

1. Stop immediately, aoid obstructing traffic if possible.  Put out emergency reflectors.  Warn oncoming traffic ULESS PERSONAL SAFETY IS JEOPARDIZED.
2. Notify Management and advise of injuries.
   • Management should:
     • notify police
     • notify medical aid to respond
3. Aid the injured.
4. Obtain name and address of investigating police officer and badge number.
5. Obtain facts about damages to your vehicle.
6. Obtain facts about damags to other vehicle(s) and/or property damage.
7. Obtain witness contact information.
8. Describe facts about injured person(s).
9. Describe the accident on the accident report.
10. Never admit liability or agree to pay for damages.
11. Do not discuss the accident except with police, or with your management representative. 

ACCIDENT INFORMATION

Date:___________________________   Time:_________________________________

Location:________________________________________________________________

Weather Conditions:______________________________________________________

Road Conditions:_________________________________________________________

Number of persons in each vehicle:________________________________________

Other Vehicle Make_______________________________________________________

Model:________________________________ Year:______________________________

OTHER DRIVER INFORMATION

Name:___________________________________________________________________

Address:_________________________________________________________________

Phone Number:__________________________________________________________

Drivers License Number:________________________ State____________________

License Plate:_____________________  State_____________ Number____________

Insurance Carrier___________________  Policy Number_______________________

OTHER DRIVERS, PASSENGERS OR PEDESTRIANS

Name:____________________________________________________________________

Address:__________________________________________________________________

Name:____________________________________________________________________

Address:__________________________________________________________________

Name:____________________________________________________________________

Address:__________________________________________________________________

WITNESSES

Name:_______________________________  Age:________________________________

Address:__________________________________________________________________

Name:_______________________________ Age:_________________________________

Address:__________________________________________________________________

Name:________________________________ Age:________________________________

Address:__________________________________________________________________

Describe any apparent injuries:______________________________________________

___________________________________________________________________________

Description of accident:___________________________________________________

__________________________________________________________________________

Describe apparent damage to your vehicle:_________________________________

__________________________________________________________________________

Describe apparent damage to other vehicle:_______________________________

__________________________________________________________________________

POLICE INVESTIGATION

Police Department:_______________________________________________________

Police Officer:____________________________________________________________

Badge Number:__________________________________________________________