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Accident Scene Information Checklist

Print this out and throw it in your glove compartment!

CONTACT AND INSURANCE INFORMATION:
Name:
Address:
Home & Work Telephones:
Cell Phone #:
Drivers License Number/State:
Insurance Company Name:
Policy Number:

VEHICLE INFORMATION:
Make:
Model:
Year:
License plate number/state:

GENERAL OBSERVATIONS:
Number of passengers in vehicles involved:
Approximate condition of passengers:
Approximate condition of vehicles involved:
Time of day:
Weather:
Road conditions:
Any other contributing conditions:

POLICE OFFICER INFORMATION:
Name of law enforcement agency:
Name(s) of officer(s) on the scene:
Case number (if assigned at the scene):

WITNESS INFORMATION:
Name:
Address:
Home telephone:
Work telephone:

INJURIES OR PROPERTY DAMAGE
Name:
Address:
Home telephone:
Work telephone:
Nature of injury or property damage:

Courtesy of the Independent Insurance Agents & Brokers of America at iiaa.org

Posted on: 12/4/06 5:08:58 P

 

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