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Fleet vehicle accident and collision documentation record
PAGE 1 OF 2
Describe what happened in factual terms: direction of travel, lane positions, speed, traffic signals, point of impact. Do not admit fault.
Sketch the road layout, vehicle positions before and after impact, direction of travel and point of collision. Mark north if known.
Damage Assessment
| # | Vehicle | Damage Location | Description of Damage | Severity |
|---|---|---|---|---|
| 1 | A (ours) | |||
| 2 | A (ours) | |||
| 3 | B (other) | |||
| 4 | B (other) | |||
| 5 | Property |
Severity: Minor (cosmetic), Moderate (functional), Major (structural), Write-off
Injuries
| # | Name | Vehicle (A/B) | Injury Description | Treatment Provided |
|---|---|---|---|---|
| 1 | ||||
| 2 |
Witness Details
| # | Name | Contact Number | Brief Statement |
|---|---|---|---|
| 1 | |||
| 2 |
Declaration
I confirm that the information recorded in this vehicle accident report is accurate and complete to the best of my knowledge. I understand that this report may be used for insurance claims, internal investigation, regulatory notification and corrective action purposes. I have not admitted fault to any party at the scene.