Vehicle Accident Report

Third-Party vehicle/property damage

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

Front of the vehicle Rear of vehicle Drivers side Passanger side Complete vehicle NO VEHICLE INVOLVED
Add aditional comments
Take a wide angle photograph of the accident area
Take a photograph of the damage 1
Take a photograph of the damage 2
Take a Photograph of the damage 3
Take a Photograph of the damage 4

Company vehicle/property damage

Please complete this section fully describing vehicle/property damage and images
Company vehicle registration number
Main damage area

Front of vehicle Rear of vehicle Drivers side Passanger side Complete vehicle
Additional comments
Take a wide angle Phototograph of the vehicle
Take a photograph of the damage 1
Take a photograph of the damage 2
Take a photograph of the damage 3
Take a photograph of the damage 4

How did the accident happen?

Please give as much detail as possible regarding how the accident happened.
Give your version of events *
Describe any conversations you had with the third party *

Witness details

Please provide name and contact number of any witnesses present
Witness 1

First Name Last Name
Phone Number

Area Code Phone Number
Witness 2

First Name Last Name
Phone Number

Area Code Phone Number
Witness 3

First Name Last Name
Phone Number

Area Code Phone Number

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
Your Name *

First Name Last Name
Employment status *

Employed by Connection Flooring Ltd Agency driver
*

As the driver of the vehicle I confirm that the information I have provided is truthfull and to the best of my knowledge
Your signature *

Clear
Should be Empty:

Vehicle Accident Form