Rideshare Accident Report
Incident Details
Date of Accident
Time of Accident
Location of Accident
Description of Accident
Rideshare Information
Rideshare Company
Trip ID (if available)
Driver Information
Driver Name
Driver Phone
Driver License Plate
Passenger Information
Your Name
Your Contact Information
Other Party Information
Other Driver Name
Other Driver Contact
Other Vehicle Details
Police Report
Police Report Filed?
Yes
No
Police Report Number
Injuries and Damages
Were there any injuries?
Yes
No
Describe Injuries or Damages