Auto Accident Report Form

Collects structured details about a vehicle accident, including drivers, vehicles, damage, witnesses, police involvement, and insurance information.

Submission Notice

• What happens after I submit?
• I understand this report may be used for internal safety review, claims handling, and insurance follow-up.

Incident Details

• Date of accident
• Time of accident
• Accident location
  Enter the street address, intersection, parking lot, or other specific location.
• Type of accident
• Brief description of what happened
• Weather conditions

People Involved

• Reporting person's name
• Reporting person's phone number
• Reporting person's email
• Did anyone report an injury?
• Injury details
  Describe the injury at a high level. Do not include medical records or more health information than necessary.

Vehicle Information

• Was a company, leased, or business-use vehicle involved?
• Company vehicle details
• Other vehicle details
  Include make, model, color, license plate, and any visible damage if known.
• Describe visible vehicle damage

Witnesses and Police

• Were there any witnesses?
• Witness details
• Was police or law enforcement contacted?
• Police report number

Insurance and Follow-Up

• Insurance company
• Policy number
• Claim number
• Is follow-up needed?
• Follow-up notes