Duty of care

Accident Report Card – More Complex

ACCIDENT REPORT FORM

If you have an Accident:

1. Stop.

2. Remain calm.

3. Call the emergency services if anyone is injured or if vehicles or property are seriously damaged. If the police attend the scene, note the reporting officer’s name, number and station.

4. Use this incident form to record information about the accident, to exchange details with third parties and to take the names and addresses of witnesses and police officers.

5. Third parties are obliged to give you their name, the vehicle registration number and insurance details under section 170 of the Road Traffic Act 1988.

6. If a camera is available, photograph the scene from different angles. Take pictures of the vehicles involved and of the damage to your own and third party vehicles/property.

7. Contact your line or transport manager and/or the insurance department as soon as it is practical to do so, using the following telephone number: _______________

 

TO BE RETAINED BY COMPANY DRIVER

 

ACCIDENT DETAILS

Date: _____________________________ Time: ___________________________________

 

Location: _______________________________________________________________________

 

_______________________________________________________________________________

 

Speed limit: _____________________________________________________________________

 

Road conditions: _________________________________________________________________

 

 

POLICE DETAILS

 

Police attended:            Y/ N                  Time: _________________________________________

 

Officer’s name: __________________________________________________________________

 

Phone: ________________________________________________________________________

 

Reporting officer’s station: _________________________________________________________

 

 

OTHER VEHICLE/PROPERTY DAMAGE

(Use additional cards if required)

 

Vehicle type: ____________________________________________________________________

 

Make/model: ____________________________________________________________________

 

Driver name: ____________________________________________________________________

 

Registration number: _____________________________________________________________

 

Address: _______________________________________________________________________

 

Phone: ________________________________________________________________________

 

Third party insurer: _______________________________________________________________

 

Policy number: __________________________________________________________________

 

Description of damage to other vehicles/property: _______________________________________

 

_______________________________________________________________________________

 

_______________________________________________________________________________

 

WITNESS DETAILS

(Use additional cards if required)

Witness 1 name: _________________________________________________________________

 

Address 1: ______________________________________________________________________

 

Phone 1: _________________________________________________________________

 

 

WRITE A BRIEF DESCRIPTION OF WHAT HAPPENED

 

________________________________________________________________________

 

________________________________________________________________________

 

________________________________________________________________________

 

________________________________________________________________________

 

________________________________________________________________________

 

 

 

________________________________________________________________________

 

________________________________________________________________________

 

 

INCIDENT SKETCH

Make a sketch of the incident scene below. Show the directions of the vehicles involved and note their approximate speeds. Indicate road markings, skid marks, hazards and the witnesses’ locations.

 

 

 

 

 

 

 

 

 

 

 

TO BE COMPLED AND TO BE GIVEN TO THE THIRD PARTY INVOLVED

(Use additional incident cards if more than one third party is involved)

DRIVER DETAILS

Driver’s name (YOU): _____________________________________________________________

 

Telephone number (YOURS): _______________________________________________________

 

Home address (YOURS): __________________________________________________________

 

Vehicle registration number (YOURS): ________________________________________________

 

Vehicle make (YOURS): ___________________________________________________________

 

Owner’s name (YOUR COMPANY): __________________________________________________

 

Owner’s address: _________________________________________________________________

 

Owner’s insurer: _________________________________________________________________

 

Policy number: __________________________________________________________________

INCIDENT DETAILS

Date: _________________________________     Time: ___________________________________

 

Incident location: _________________________________________________________________

 

____________________________________________________________________________________

 

Description of damage to other vehicles/property: _______________________________________

_______________________________________________________________________________

 

 

Signature (YOURS): ____________________________________

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