This is a sample only:

If you have an incident:

1. Stop.
2. Remain calm.
3. Call the emergency services if anyone is injured or if vehicles or property are seriously damaged. If the police attend the scene, note the reporting officer’s name, number and station.
4. Use this incident form to record information about the accident, to exchange details with third parties and to take the names and addresses of witnesses and police officers.
5. Third parties are obliged to give you their name, the vehicle registration number and insurance details under section 170 of the Road Traffic Act 1988.
6. If a camera is available, photograph the scene from different angles. Take pictures of the vehicles involved and of the damage to your own and third party vehicles/property.
7. Contact your line or transport manager and/or the insurance department as soon as it is practical to do so, using the following telephone number: ________________

TO BE RETAINED BY COMPANY DRIVER

ACCIDENT DETAILS

Date:
Time:
Location:
Speed Limit:
Road Conditions:

POLICE DETAILS

Police Attended: Y/ N Time:
Officer’s Name:
Phone:
Reporting Officer’s Station:

OTHER VEHICLE/PROPERTY DAMAGE (Use additional cards if required)

Vehicle Type:
Make/Model:
Driver Name:
Registration Number:
Address:
Phone:
Third Party Insurer:
Policy number:
Description of damage to other vehicles/property:

WITNESS DETAILS (Use additional cards if required)

Witness 1 Name:
Address 1:
Phone 1:
Witness 2 Name:
Address 2:
Phone 2:

WRITE A BRIEF DESCRIPTION OF WHAT HAPPENED

INCIDENT SKETCH
Make a sketch of the incident scene below. Show the directions of the vehicles involved and note their approximate speeds. Indicate road markings, skid marks, hazards and the witnesses’ locations.

TO BE COMPLED AND TO BE GIVEN TO THE THIRD PARTY INVOLVED
(Use additional incident cards if more than one third party is involved)
DRIVER DETAILS

Driver’s Name (YOU):
Telephone Number (YOURS):
Home Address (YOURS):
Vehicle Registration Number (YOURS):
Vehicle Make (YOURS):
Owner’s Name (YOUR COMPANY):
Owner’s Address:
Owner’s Insurer:
Policy Number:
 
INCIDENT DETAILS

Date: 
Time:
Incident Location:
Description of damage to other vehicles/property:
Signature (YOURS): _____________________________________