Accident Reporting

Accident report
Wearing seat belt
Using cell phone
Airbags deployed

Information about other vehicles

Information About the Accident

Police involved *

Information about injuries

If injuries were to the employee an employee injury/investigation report must be completed

Traveling in your vehicle
Traveling in other vehicles
Was the driver in control of the vehicle at the time of the incident
Were pictures taken *

Employee Vehicle Accident Review

(For reviewing all vehicle accidents. To be filled out by the driver. Not for claim purposes.)

Seat belts worn
Were you on the cell phone