Vehicle Accident Report

• Site conducted

  Select

• Driver Information

• What is the GSA Tag #:

• SNJCC Case #:

• Department

  Select Security Residential Vocations Center Support Staff OA/CTS Support Services Other Private Party(s) Transportation Department WBL Site Student Driver

  • Security
  • Residential
  • Vocations
  • Center Support Staff
  • OA/CTS
  • Support Services
  • Other
  • Private Party(s)
  • Transportation Department
  • WBL Site
  • Student Driver

• What is their license plate tag #

• What is the WBL location?

• Was there any property damage?

  Yes

  No

  N/A

• What occured?

• Was anyone injured? If so, who and/or what?

• What student?

• Which Vehicle?

• Was anyone else involved?

  Yes

  No

  N/A

• Was anyone injured?

• Vehicle Insurance information

• Conducted on

  Date

• Prepared by

  CSO Vance Schuening

  Other

• Who completed the initial investigation

General Information

• Date the accident happened

  Date

• Date and time of investigation

  Date

• Exact location of accident

• Take photo of the location where accident happened

  Media

• Weather condition

  Select Cloudy Clear Dark Fog Ice Rain Snow Twilight Windy

  • Cloudy
  • Clear
  • Dark
  • Fog
  • Ice
  • Rain
  • Snow
  • Twilight
  • Windy

• Type of Road Surface

  Asphalt

  Concrete

  Dirt

  Gravel

• Condition of Road Surface

  Good

  Fair

  Poor

Vehicle Information

• Vehicle type

  Light Vehicle

  Heavy Vehicle

• Select vehicle identification type

  Select VIN License Plate # Other

  • VIN
  • License Plate #
  • Other

• VIN

• Take photo of license plate

  Media

• Year, Make and Model

• Driver's Speed

• Direction of Travel

  Select North South East West

  • North
  • South
  • East
  • West

Accident Details

• Select the root cause

  Select Reckless Driving Driver not attentive Conflict with passengers Vehicle mechanical issue Caused by other vehicles Bad weather Animal crossing Other Struck an objecgt

  • Reckless Driving
  • Driver not attentive
  • Conflict with passengers
  • Vehicle mechanical issue
  • Caused by other vehicles
  • Bad weather
  • Animal crossing
  • Other
  • Struck an objecgt

• Describe unattentiveness

  Drunk

  Influenced by drugs

  Sick

  Other

• 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

  Slightly Damaged

  Severely Damaged

• Take photo of vehicle

  Media

• Provide detailed descriptions of the physical damages

• Was there a collision?

  Yes

  No

• Draw a diagram of collision

  Drawing

• Provide details of the vehicle involved

• Describe the damages of vehicle

  Slightly Damaged

  Severely Damaged

• Take photo of vehicle

  Media

• Provide detailed descriptions of the physical damages

• After the accident, is the vehicle safely drivable?

  Yes

  No

• Was the vehicle towed?

  Yes

  No

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

  Sign

• Ask the details about the incident

Recommendation

• State some recommendations

Completion

• Full Name and Signature of Inspector

  Sign

Additional Information

• undefined