Title Page
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Project Name
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Conducted on
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Prepared by
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Location
Incident / Accident Details
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As described in Harvest Energy Solutions Vehicle Policy, all accidents regardless of the severity must be reported. Accidents on public roadways and parking lots are to be reported to the police and a police report obtained. Damage to company equipment on private property and/or during the course of work is to be reported to the area supervisor immediately.
Once damage to company property is reported, this report is to be completed and submitted to the area supervisor/manager within 24 hours. This should include pictures in order to show the damage being reported.
Damage to company property and equipment can impact the performance of the equipment, therefore, failure to report damage of company equipment is a serious concern. Failing to report damage to company vehicles is grounds for disciplinary action up to and including termination. -
Date of Incident:
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Asset Number:
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Name of Driver:
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Department:
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Vehicle Description:
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Description of Damage:
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What happened?
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Other Driver Information: Name, Phone, Insurance/Policy #
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Witnesses to the incident? Name/Phone
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Responding Police Dept:
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Officer Name/Phone:
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Police Report #:
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Employee Signature:
Office Use Only
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Reported to Insurance Company
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Police Report Included
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Estimate needed for Repair
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Pictures included
