Car Accident Information To Collect

If you've been in a car accident, it's important to gather up all the relevant details -- how the accident happened, who was involved, who witnessed the crash, etc. To make sure you've collected all necessary information related to your car accident (and that the data is all in one place), print this form out and write your answers in the space provided. You may even want to carry a blank copy of this form in your glove compartment.

Car Accident Information Form

Take photos of:

• Overall scene - from different angles; close up and far away

• Damage to other vehicle(s)

• Damage to your vehicle

• "Things" or objects involved (such as debris on highway, skid marks)

Your Vehicle Owner Make, model & year Color License No. Your car was struck:

• In the rear: Left or right?

• Driver's Side

• Passenger side

• Front: Left or right?

• Other

Other Driver Name Address Telephone Driver's License No. Insurance Company Policy Number Agent name and telephone Statement Make sure to collect everyone’s information who was involved.   Other Vehicle(s) Owner Address Telephone Make, model & year Color License No. Where damaged Describe the damage Witnesses Name Address Telephone Statement Accident Facts Date Time Location Weather was:

• Clear

• Cloudy

• Raining

• Snow

• Fog

• Windy

Visibility was:

• Daylight

• Dawn

• Dusk

• Dark

Road surface was:

• Dry

• Wet

• Snow

• Ice

• Mud

In area of the crash, the road was:

• Straight

• Curved

In area of the crash, the road grade was:

• Level

• Uphill

• Downhill

Traffic conditions were:

• Heavy

• Light

• Medium

• Other

Other You were:

• The driver

• Front seat passenger

• Rear seat passenger

• Pedestrian

Check the things involved in your accident and explain

• Stopped vehicle

• Turning vehicle

• Traffic signs

• Traffic signal

• Alcohol

• Excessive speed

• Turn signals

• Headlights

• Stoplights

• Skid marks

• Debris on road (what and where - make a picture)

• Pedestrians

• Parked car

• Cyclist

• Guardrail or light pole

• Fence or embankment

• Fixed object (wall, building, etc)

• Rollover

• Fire

• Intersection

• Ramp

Damage to Property Other than Vehicles (such as parked car, mailbox, fence, light pole, etc.) What property Owner Address Telephone Nature of damage Your Injuries At the time of the collision: Were you wearing a seatbelt?

• Yes

• No

Your airbag deployed and hit you.

• Yes

• No

You hit your head on the:

• Headrest

• Steering wheel

• Windshield

• Visor

• Roof

• Side window

Knocked unconscious

• Yes

• No

• Not sure

Describe where you have:

• Pain

• Numbness

• Tingling

• Burning

• Stiffness

• Bruises

• Bumps

• Scrapes

Injuries to Others Name Address Telephone Type of injury Police Information Officer's name Badge number Law enforcement agency Telephone Report No. Ticket issued Ambulance Information Agency Telephone Report No. Towing Information Company Address Telephone Where vehicle taken Storage Facility Information Company Address Telephone