Duty of care

A Simple Accident Report Card

ACCIDENT REPORT

 

COMPANY NAME: ________________________________________________________________________________

 

OUR NAME:  __________________________________   YOUR REGISTRATION  NUMBER  _________________

 

CRASH DETAILS

 

DATE:  __________  TIME:  __________  LOCATION:  _____________________________________________

 

ROAD CONDITION: _______________________________________________  SPEED LIMIT OF ROAD: _______MPH

POLICE DETAILS

 

ARE POLICE IN ATTENDANCE: __________NAME OF OFFICER: __________________________________________

 

NAME OF STATION: _________________________  TELEPHONE NUMBER:  _______________________________

 

DAMAGE TO OTHER VEHICLE / PROPERTY

VEHICLE MAKE / MODEL:  ____________________________________     REGISTRATION NUMBER:  ____________

 

DRIVER NAME:______________________________________________  TELEPHONE NUMBER:_________________

 

ADDRESS:  _______________________________________________________________________________________

 

THIRD PARTY INSURER / POLICY NUMBER: ___________________________________________________________

 

DESCRIPTION OF DAMAGE

 

_________________________________________________________________________________________________

 

_________________________________________________________________________________________________

WITNESSES

 

NAME: _________________________________   ADDRESS:_______________________________________________

 

_________________________________________________________________________________________________

 

NAME: _________________________________   ADDRESS:_______________________________________________

 

 

BRIEF DESCRIPTION OF WHAT HAPPENED

 

_________________________________________________________________________________________________

 

_________________________________________________________________________________________________

 

_________________________________________________________________________________________________

 

SKETCH   (Please use reverse of this form if more detail is required)

 

 

 

 

 

 

 

 

 

 

 

(This part of the report should be detached and given to the other party)

 

DATE:  _______________  TIME:  ____________   REGISTRATION NUMBER: ________________________________

 

LOCATION: ______________________________________________________________________________________

 

COMPANY DRIVER NAME: _______________________________________  TELEPHONE NUMBER:______________

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