At the Scene Of Your Car Accident, Use These Accident Information Forms


	Accident Information Form Describe How Your Accident Happened Diagram How Your Accident Happened (Identify vehicles. Yours is 1 and others are 2, 3, 4 . . . Show direction of travel with arrows) Photographs to Take Make pictures of . . . ❏ Overall scene - from 4 directions, both close and far ❏ Damage to other vehicle(s) ❏ Damage to your vehicle ❏ "Things" or Objects involved (such as debris on highway, skidmarks) Your Vehicle Owner Make, model & year Color License No. Your car was struck . . . ❏ In the rear ❏ In the right rear ❏ In the left rear ❏ On the driver's side ❏ On the passenger's side ❏ In the front ❏ In the left front ❏ In the right front ❏ Other (explain) Where damaged Describe the damage Other Driver Name Address Telephone Work Telephone Driver's License No. Insurance Company Policy Number Agent name and telephone Statement ❏ If more than 1 other driver, mark here and write the information on the back. Other Vehicle(s) Owner Address Telephone Work Telephone Make, model & year Color License No. Where damaged Describe the damage ❏ If more than 1 other vehicle, mark here and write the information on the back. Witnesses Name Address Telephone Work Telephone Location (passenger, other driver, pedestrian) Statement ❏ If additional witnesses, mark here and write information on the back. Accident Facts Date Time Location Weather was . . . ❏ Clear ❏ Cloudy ❏ Raining ❏ Snow ❏ Fog ❏ Windy Visibility was ... ❏ Daylight ❏ Dawn ❏ Dusk ❏ Dark Road conditions (any defects) Road surface was . . . ❏ Dry ❏ Wet ❏ Snow ❏ Ice ❏ Mud In the area of the crash, the road was . . . ❏ Straight ❏ Curved In the area of the crash, the road grade was . . . ❏ Level ❏ Uphill ❏ Downhill Traffic conditions were . . . ❏ Heavy ❏ Medium ❏ Light ❏ 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 ❏ Turning vehicle ❏ 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 Work Telephone Type of injury ❏ If more than 1 other injured person, mark here and write the information on the back. Police Information Officer's name Police Agency Telephone Report No. Ticket issued To whom Ambulance Information Agency Telephone Report No. Towing Information Company Address Telephone Where vehicle taken Storage Facility Information Company Address Telephone	Videos Coming!! The First Car Accident Claim Self-help Videos Anywhere Only $10 Each! Guaranteed to put $ in your pocket. A legal insider pulls back the curtain and reveals Jedi level secrets. Customizable -- Only pay for the help you need. KNOW you are getting all you deserve for your claim. To be notified when the Videos are released -- and qualify for an Early Bird Discount -- click here. New Ebook The Car Accident Claims Kit is based on The Car Accident Claims Checklist that I created and it gives you all the forms, information and examples you need to settle your claim without a lawyer. To learn more, click here.
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