Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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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:
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* Contact immediate supervisor/fleet/safety administrator.
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* Complete the Vehicle Incident report at the scene if able to or as soon as possible.
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* 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
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Note: This form should be in an envelope marked " Accident Kit " and placed in the glove box of each company vehicle.
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Employee's Name
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D.O.B.
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Date of Occurrence
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Time of Incident
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Choose one
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Driver Licenses Number
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State
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Location of Occurrence: Street/ Hwy., City and State.
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License Plate #, State and Vin #
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Type of Vehicle: Year, Make, Model, Color.
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What are the damages to our vehicle
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Passengers
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How many
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
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Injuries
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Passengers Names
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Owned by
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Witnesses
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Names and Phone
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Add signature
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Select date
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Add signature
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Select date