Accident Information FormINDEX...HOME Good Sites Fill out this form at the scene of the accident. The Other Driver and His or Her Car Name of other driver ______________________________________________ Street address __________________________________________________ City________________________________________ State______________ Vehicle registration (car license) number _____________________________ Make and type of car________________________________ Year ________ Driver's license number ___________________________________________ Has he or she apparently been drinking? _____________________________ Any verbal statement made by other driver as to cause of accident ________ _______________________________________________________________ _______________________________________________________________ Names and Addresses of Passengers in Other Car Name _________________________________________________________ Address _______________________________________________________ Name _________________________________________________________ Address _______________________________________________________ Names and Addresses of All Possible Witnesses to Any Fact Name _________________________________________________________ Address _______________________________________________________ Name _________________________________________________________ Address _______________________________________________________ Name _________________________________________________________ Address _______________________________________________________ Special Conditions to Note Immediately Following Accident Position of your car after accident __________________________________ ______________________________________________________________ Position of other car after accident _________________________________ ______________________________________________________________ Location of any tire marks, blood, broken glass, dirt, etc., on road or side of road ____________________________________________________ ______________________________________________________________ Location of point of impact in relation to center of road or some physical object _________________________________________________ ______________________________________________________________ Did your car skid? If so, how many feet? _____________________________ _______________________________________________________________ Did the other car skid? If so, how many feet? _________________________ _______________________________________________________________ Road conditions _________________________________________________ Traffic conditions ________________________________________________ Weather conditions ______________________________________________ Traffic controls (traffic lights, stop signs, etc.) _________________________ _______________________________________________________________ Place of impact on other car _______________________________________ Name and address of any wrecker that removes other cars ______________ _______________________________________________________________ Other conditions that might have bearing on accident ___________________ _______________________________________________________________ _______________________________________________________________ The following may be filled out either at the scene or shortly after leaving the scene Date of accident _________________________________________________ Time __________________________________________________________ Location of accident _____________________________________________ Type of road (grade, curve, etc.) ____________________________________ Speed of your car just before accident ________________________________ Speed of other car just before accident ________________________________ Direction of your car ______________________________________________ Direction of other car _____________________________________________ Were you or other driver turning? ____________________________________ Did other driver signal properly (with arm, horn, lights, etc.)? ______________ If at night, were his or her lights on? __________________________________ How far were you from the other car when you first saw it? ________________ Investigating police officer: _________________________________________ Other pertinent facts: ______________________________________________ _______________________________________________________________ |