Accident Checklist

Accident Checklist

GET THESE FACTS IN CASE OF ACCIDENT:

DATE OF ACCIDENT:_____________TIME:_____________

EXACT LOCATION:__________________________________

WEATHER CONDITION:_____________________________

OTHER DRIVERS INFORMATION:
NAME:_____________________________________________
ADDRESS:__________________________________________
DRIVERS LICENSE NUMBER:________________________
YEAR/MAKE/MODEL:_______________________________
VEHICLE LICENSE#:_______________STATE:__________
PHONE#:__________________________________________

INSURANCE COMPANY:____________________________
INSURANCE POLICY #:_____________________________
DESCRIPTION OF DAMAGE TO OTHER CAR:__________
__________________________________________________
__________________________________________________
__________________________________________________

WITNESSES INFORMATION
OFFICER PRESENT:_______________BADGE#:_________

WITNESS NAME:_________________PHONE#:__________
ADDRESS:_________________________________________

WITENSS NAME:_________________PHONE#:__________
ADDRESS:_________________________________________

INJURED INFORMATION
NAME:__________________________PHONE#:__________
ADDRESS:_________________________________________
COMPLAINTS:______________________________________

NAME:__________________________PHONE#:__________
ADDRESS:_________________________________________
COMPLAINTS:_____________________________________

DRAW A DIAGRAM OF THE ACCIDENT SCENE SHOWING THE DIRECTION OF ALL VEHICLES INVOLVED, POINT OF IMPACT, STREET NAMES AND LOCATION OF STREET SIGNS.

DESCRIBE ANY OTHER DAMAGE OR PERTINENT DETAILS BELOW:

____________________________________________________________

ALLIANCE AUTO CENTERS
12007 MURPHY ROAD
HOUSTON, TX 77031
(281)561-6868
FAX: (281)561-6871
E-MAIL: ewhichard@allianceautocenter.com