Company Car Accident Internal Report
General Information
Date of Report
Reported By
Department
Driver Information
Driver Name
Driver License Number
Contact Number
Position / Job Title
Vehicle Information
Vehicle Make/Model
Vehicle Registration Number
Mileage at Time of Accident
Accident Details
Date of Accident
Time of Accident
Location
Description of Accident
Weather and Road Conditions
Was the police notified?
Yes
No
Police Report Number
Other Parties Involved
Name
Contact Number
Vehicle Details
Insurance Details
Damage and Injury Report
Damage to Company Vehicle
Damage to Other Property
Injuries (if any)
Witness Information
Name
Contact Number
Witness Statement
Internal Notes
Further Action Required
Additional Comments