Information

  • Audit Title(e.g. Accident involving said driver and another car or property)

  • Personnel Involved:

  • Call Taken By:

  • Date & Time of Collision:

  • Location of Collision:

  • Date & Time Reported

  • Todays Date

  • Prepared by

Questions to ask driver after first finding out if the driver is OK:

  • 1. Are there any injuries, fatalities, or hazardous material spills?

  • 1.1 If injuries, has anyone attempted to give first aid or help the injured?

  • 1.2 Have you or anyone else called 911 if appropriate?

  • 1.3 Have you or anyone else reported the collision to the police?

  • 1.4 Has or does it appear that anyone will be transported from the scene for medical treatment?

  • 1.5 Will any of the vehicles need to be towed?

  • 1.6 If there was a HAZMAT spill, what is the HAZMAT material? Color of placard? Number on placard?

  • 2. Have you secured the collision scene to prevent further damage and possibly another collision from occurring?

  • 2.1 Have warning devices been used and set out? (4-way flashers, triangles, cones, flares, etc.)

  • 2.2 Is there any lane blockage?

  • 3. Have you entered the collision in XATA to activate the final minute log or accident report feature?

  • 4. Have you documented the names, vehicle and driver's license numbers, insurance information, addresses & telephone numbers of all parties involved?

  • 5. Have you documented any driver license restriction codes of the other driver?

  • 6. Have you obtained names, addresses & telephone numbers of witnesses?

  • 7. Have you taken photos of the collision scene?

  • 8. Have you completed a simple yet detailed diagram of the collision scene?

  • 9. Can you and our unit(s) proceed safely?

  • 9.1 Is a mechanic needed?

  • 9.2 is your load secured?

  • 9.3 Are you going to remain legally within the hours of service?

  • 10. Does there appear to be any public relations concern?

  • 10.1 If so, what is the concern? (Television, newspaper, radio, other)

  • Describe briefly what happened:

  • If any available pictures, add here:

Signatures

  • Auditors Signature

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.