Company Vehicle Accident Report Form

Employee Name Department Job Title Date of Report

Vehicle Make & Model License Plate Number Vehicle ID / Asset Number

Date of Accident Time of Accident Location of Accident

Describe How The Accident Happened Damage to Company Vehicle

Were there any injuries? No Yes If yes, describe the injuries and persons involved

Were other vehicles involved? No Yes If yes, give details

Police Notified? Yes No Police Report Number

Additional Comments

Signature Date