Information
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Audit Title(e.g. Accident involving said driver and another car or property)
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Personnel Involved:
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Call Taken By:
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Date & Time of Collision:
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Location of Collision:
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Date & Time Reported
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Todays Date
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Prepared by
Questions to ask driver after first finding out if the driver is OK:
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1. Are there any injuries, fatalities, or hazardous material spills?
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1.1 If injuries, has anyone attempted to give first aid or help the injured?
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1.2 Have you or anyone else called 911 if appropriate?
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1.3 Have you or anyone else reported the collision to the police?
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1.4 Has or does it appear that anyone will be transported from the scene for medical treatment?
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1.5 Will any of the vehicles need to be towed?
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1.6 If there was a HAZMAT spill, what is the HAZMAT material? Color of placard? Number on placard?
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2. Have you secured the collision scene to prevent further damage and possibly another collision from occurring?
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2.1 Have warning devices been used and set out? (4-way flashers, triangles, cones, flares, etc.)
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2.2 Is there any lane blockage?
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3. Have you entered the collision in XATA to activate the final minute log or accident report feature?
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4. Have you documented the names, vehicle and driver's license numbers, insurance information, addresses & telephone numbers of all parties involved?
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5. Have you documented any driver license restriction codes of the other driver?
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6. Have you obtained names, addresses & telephone numbers of witnesses?
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7. Have you taken photos of the collision scene?
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8. Have you completed a simple yet detailed diagram of the collision scene?
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9. Can you and our unit(s) proceed safely?
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9.1 Is a mechanic needed?
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9.2 is your load secured?
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9.3 Are you going to remain legally within the hours of service?
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10. Does there appear to be any public relations concern?
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10.1 If so, what is the concern? (Television, newspaper, radio, other)
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Describe briefly what happened:
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If any available pictures, add here:
Signatures
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Auditors Signature
