In case of an auto accident, please keep this in your car with
your insurance and registration information.
AVOID A SECOND ACCIDENT
Remain Calm. Stop safely. Turn emergency lights on.
Watch for oncoming traffic.
CALLS TO MAKE
Call the police Call your insurance carrier.
IDENTIFY WITNESSES
Be sure to ask witnesses for their complete address and contact information.
PROVIDE CONTACT INFORMATION
Exchange insurance and contact information with the other driver.
STICK TO THE FACTS
Let the facts speak for themselves.
Tell the investigating officer just what happened.
TAKE PHOTOS
If your injuries permit, use your cell phone, camera
or digital camera to take photos of:
All four sides of each vehicle.
Close-up shots of damages areas.
People, passengers and witnesses.
License plates including witness vehicles.
Skid marks and debris
Vehicle interiors
Entire scene
RECORD THE FACTS FOR YOUR ATTORNEY
AND YOUR INSURANCE COMPANY
Accident Date:___________________________Time:________________
Where:_____________________________________________________
OTHER VEHICLE (get directly from vehicle registration card)
Vehicle Lic. # ____________________State:_______
Make_____________Model _________Color_______
Owner Name________________________________
Address ____________________________________
City/State/Zip_______________________________
OTHER DRIVER (get directly from driver’s license)
Name: _____________________________________
Address: ____________________________________
____________________________________
License # __________________
______State:_______
Home/Cell Phone:____________________________
Email: _____________________________________
Was driver on any assignment for owner? Yes No
INSURANCE
Company_________________ Phone_____________
Policy Holder _____________ Policy #__________
Weather Condition: clear, rain, fog, hail, snow other: __________________________
Road surface: clear, wet, unpaved, pot holes, icy other: _________________________
POLICE OFFICER_____________________________
Report Number:________________________________
Describe What Happened:
______________________________________________
______________________________________________
______________________________________________
______________________________________________
______________________________________________
WITNESS INFORMATION
Name: _____________________________________
Phone: _____________________________________
Address: ____________________________________
____________________________________
Home/Cell Phone:____________________________
Email: _____________________________________
Name: _____________________________________
Phone: _____________________________________
Address: ____________________________________
____________________________________
Home/Cell Phone:____________________________
Email: _____________________________________
Name: _____________________________________
Phone: _____________________________________
Address: ____________________________________
____________________________________
Home/Cell Phone:____________________________
Email: _________________________________
____
Name: _____________________________________
Phone: _____________________________________
Address: ____________________________________
____________________________________
Home/Cell Phone:____________________________
Email: _____________________________________
