Vehicle Incident Report

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

If you are involved in an INCIDENT, i.e., crack windshield, scratch to vehicle, dent, paint problems, hail damage, etc then fill out this report:

• * Contact immediate supervisor/fleet/safety administrator.

• * Complete the Vehicle Incident report at the scene if able to or as soon as possible.

• * You may provide the other party involved in the accident with your name, the company name, the company phone number, vehicle identification and insurance information, BUT do not accept responsibility or admit liability. This is a "legal call" that should be made by our insurance company's claims department.

Place this procedure in the manila envelope marked " Accident Kit " in the glove box of each Alpha Insulation & Waterproofing vehicle.

Vehicle Incident Report

• Note: This form should be in an envelope marked " Accident Kit " and placed in the glove box of each company vehicle.

• Employee's Name

  Yes

  No

  N/A

• D.O.B.

  Yes

  No

  N/A

• Date of Occurrence

  Yes

  No

  N/A

• Time of Incident

  Yes

  No

  N/A

• Choose one

  AM

  PM

• Driver Licenses Number

  Yes

  No

  N/A

• State

  Yes

  No

  N/A

• Location of Occurrence: Street/ Hwy., City and State.

  Yes

  No

  N/A

• License Plate #, State and Vin #

  Yes

  No

  N/A

• Type of Vehicle: Year, Make, Model, Color.

  Yes

  No

  N/A

• What are the damages to our vehicle

  Yes

  No

  N/A

• Passengers

  Yes

  No

• How many

  Select 1 2 3 4 5 6 7 8

  • 1
  • 2
  • 3
  • 4
  • 5
  • 6
  • 7
  • 8

• Injuries

  Yes

  No

• Passengers Names

  Yes

  No

  N/A

• Owned by

  Company

  Employee

  Business Use

  Personal Use

• Witnesses

  Yes

  No

• Names and Phone

  Yes

  No

  N/A

• Add signature

  Sign

• Select date

  Date

• Add signature

  Sign

• Select date

  Date