Auto Accident

Auto Accident

Posted by Safe In4 Hub

Accident Information Form



Fill out this form at the scene of the accident.

The Other Driver and His or Her Car
Name of other driver ______________________________________________
Street address __________________________________________________
City________________________________________ State______________
Vehicle registration (car license) number _____________________________
Make and type of car________________________________ Year ________
Driver's license number ___________________________________________
Has he or she apparently been drinking? _____________________________
Any verbal statement made by other driver as to cause of accident ________
_______________________________________________________________
_______________________________________________________________

Names and Addresses of Passengers in Other Car
Name _________________________________________________________
Address _______________________________________________________
Name _________________________________________________________
Address _______________________________________________________

Names and Addresses of All Possible Witnesses to Any Fact
Name _________________________________________________________
Address _______________________________________________________
Name _________________________________________________________
Address _______________________________________________________
Name _________________________________________________________
Address _______________________________________________________

Special Conditions to Note Immediately Following Accident
Position of your car after accident __________________________________
______________________________________________________________
Position of other car after accident _________________________________
______________________________________________________________
Location of any tire marks, blood, broken glass, dirt, etc., on road or
side of road ____________________________________________________
______________________________________________________________
Location of point of impact in relation to center of road or some
physical object _________________________________________________
______________________________________________________________
Did your car skid? If so, how many feet? _____________________________
_______________________________________________________________
Did the other car skid? If so, how many feet? _________________________
_______________________________________________________________
Road conditions _________________________________________________
Traffic conditions ________________________________________________
Weather conditions ______________________________________________
Traffic controls (traffic lights, stop signs, etc.) _________________________
_______________________________________________________________
Place of impact on other car _______________________________________
Name and address of any wrecker that removes other cars ______________
_______________________________________________________________
Other conditions that might have bearing on accident ___________________
_______________________________________________________________
_______________________________________________________________

The following may be filled out either at the scene or shortly after
leaving the scene
Date of accident _________________________________________________
Time __________________________________________________________
Location of accident _____________________________________________
Type of road (grade, curve, etc.) ____________________________________
Speed of your car just before accident ________________________________
Speed of other car just before accident ________________________________
Direction of your car ______________________________________________
Direction of other car _____________________________________________
Were you or other driver turning? ____________________________________
Did other driver signal properly (with arm, horn, lights, etc.)? ______________
If at night, were his or her lights on? __________________________________
How far were you from the other car when you first saw it? ________________
Investigating police officer: _________________________________________
Other pertinent facts: ______________________________________________
_______________________________________________________________

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