• Connection Flooring Ltd. Henson Close, South Church Enterprise Park, DL14 6WA
  • Vehicle Accident Form

    Vehicle Accident Form

    This form must be completed at the scene of the accident to ensure all details needed are collected. You will be required to take photographs during the completion of the form. If required please take a video recording of the area and damage etc to back up your statement, this can be passed to your transport manager later.
  • First Steps To Follow

    1. Assess any injuries to yourself and others and call 999 if needed.
    2. DO NOT admit liability, avoid saying sorry or accepting the blame.
    3. If possible move your vehicle to a safe place off the main road.
    4. Call the Police if needed and wait for them to attend.
    5. Exchange information with those involved and ensure you complete this form.
    6. Take photo's of the area and any damage to all vehicles.
    7. Retain any witnesses, you can add contact details of any witnesses in this form.

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  • Details of the third party involved

    Please give details of others involved in the accident. If there is a number of vehicles/persons involved these need to be recorded on paper and given to the transport manager asap.

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  • Details about the accident

    Please complete accurately and giving as much detail as possible. 

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  • Third-Party vehicle/property damage

    Please complete this section fully describing vehicle/property damage and images

  • Company vehicle/property damage

    Please complete this section fully describing vehicle/property damage and images

  • How did the accident happen?

    Please give as much detail as possible regarding how the accident happened.

  • Witness details

    Please provide name and contact number of any witnesses present

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  • Driver declaration

    Knowingly giving a false representation of fabrication of the truth may be a criminal offence and will also lead to gross misconduct.

    The information from this form will be kept as a record to allow the company to comply with the Health & Safety at Work Regulations 1974 and for the purpose of insurance claims. All data will be collected, used and stored in line with GDPR. The use of advanced electronic signatures is in line with 'article 3' of eIDAS regulations

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