Title Page

  • Department

  • What is the GSA Tag #:

  • What is their license plate tag #

  • Vehicle Insurance information

  • Conducted on

  • Prepared by

  • Who completed the initial investigation

General Information

  • Date the accident happened

  • Date and time of investigation

  • Exact location of accident

  • Take photo of the location where accident happened

  • Weather condition

  • Type of Road Surface

  • Condition of Road Surface

Vehicle Information

  • Vehicle type

  • Select vehicle identification type

  • VIN

  • Take photo of license plate

  • Year, Make and Model

  • Driver's Speed

  • Direction of Travel

Accident Details

  • Select the root cause

  • Describe unattentiveness

  • Other reasons

  • What part/s of the vehicle had issues and caused the accident to occur?

  • List other root cause and provide detail information

  • What object

  • Describe the incident

  • Describe the damages of vehicle

  • Take photo of vehicle

  • Provide detailed descriptions of the physical damages

  • Was there a collision?

  • Draw a diagram of collision

  • Provide details of the vehicle involved

  • Describe the damages of vehicle

  • Take photo of vehicle

  • Provide detailed descriptions of the physical damages

  • After the accident, is the vehicle safely drivable?

  • Was the vehicle towed?

Passenger Profile

  • How many people are involved in the accident?

  • How many are injured?

  • How many are fatal?

  • Click the "Add Passenger" button to list the passengers involved in the accident

  • Passenger
  • Name and Signature

  • Ask the details about the incident

Recommendation

  • State some recommendations

Completion

  • Full Name and Signature of Inspector

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.