Craft Health Vehicle Accident Report

WHEN AN ACCIDENT HAPPENS:
1. Stop immediately, avoid obstructing traffic if possible. Warn oncoming traffic UNLESS PERSONAL SAFETY IS JEOPARDIZED
2. Notify police, emergency personnel (if needed), and your supervisor and HR and advise of .
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 damages to other vehicle(s) and/or property damage.
7. Take photos of damaged vehicle(s) if able.
8. Obtain witness contact information.
9. Describe facts about injured person(s).
10. Describe the accident on the accident report.
11. Never admit liability or agree to pay for damages.
12. Do not discuss the accident except with police, HR or your supervisor.

This report needs to be completed on the same day as the accident. If you are injured and unable to fill out the report at the scene, the report needs to be filled out on the next business day.

Accident Information

Name *

First

Last

Work Email *

Date and Time of Accident *

Date

Time

Location of Accident *

Weather Conditions *

Road Conditions *

Number of Persons in Each Vehicle *

Other Vehicle Make, Model & Year *

Other Driver Information

Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Drivers License Number & State *

License Plate Number & State *

Insurance Carrier & Policy Number *

If any other drivers involved, please provide their information below (Name, Address, Phone, Drivers License Number & State, License Plate Number & State, Insurance Carrier & Policy Number)

Witnesses

Witness 1 Name

First

Last

Witness 1 Address

Address Line 1

Address Line 2

City

State

Zip Code

Witness 2 Name

First

Last

Witness 2 Address

Address Line 1

Address Line 2

City

State

Zip Code

Accident Information

Describe Any Apparent Injuries *

Description of Accident *

Describe Apparent Damage to Your Vehicle *

Describe Apparent Damage to Other Vehicle(s) *

Police Investigation

Police Department *

Police Officer *

Badge Number *

I understand that by typing my name below and clicking on "Submit", I am electronically signing this document and am certifying that the above information is true and correct. A copy of this form will be emailed to you and HR. *

Date *