Solid Waste Service Vehicle Accident / Incident Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Types of Vehicles Involved

• Total Number of Vehicles Involved

  Select One Two Three Four Five Six

  • One
  • Two
  • Three
  • Four
  • Five
  • Six

• COV Vehicle Type

  Select Automation Truck Rear Load Truck Sweeper Truck Flusher Truck Cargo Truck Dump Truck Roll Off Truck Pick-up truck Car Van Scooter

  • Automation Truck
  • Rear Load Truck
  • Sweeper Truck
  • Flusher Truck
  • Cargo Truck
  • Dump Truck
  • Roll Off Truck
  • Pick-up truck
  • Car
  • Van
  • Scooter

• POV Vehicle Type

Driver Information

• Name

• Employee Number

• Driver license Number

• Time of Incident

• Today's date

  Date
• Location of Incident
  Address

• Service

  Select Area 1 Garbage Area 2 Garbage Area 3 Garbage Area 1 Yard Waste Area 2 Yard Waste Bulky Special Services

  • Area 1 Garbage
  • Area 2 Garbage
  • Area 3 Garbage
  • Area 1 Yard Waste
  • Area 2 Yard Waste
  • Bulky
  • Special Services

Vehicle / Damage Information

• License Plate Number

• Unit Number

• Year / Make / Model

• Part Damage

• Picture of COV Damage

  Media

Drivers Description of Incident / Accident

• Drivers Statement

• Draw Diagram of Accident

  Drawing

• Drivers Signature

  Sign

Labor / Passenger Information if Applicable

• Name

• Employee Number

• Labor / Passenger Statement

• Labor / Passenger Signature

  Sign

Witnesses

• Name

• Phone Number

• Witness Description of Accident / Incident

Other Vehicle Information

• Drivers Name

• Vehicle Make / Model

• License Plate Number

• Parts Damage

• Picture of POV Damage

  Media

• Other Drivers Description of Accident / Incident

Investigating Officer

• Investigators Comments

• Name and Title

• Phone Number

• Date and Time

  Date

• Signature

  Sign