Appendix D VEHICLE ACCIDENT INVESTIGATION REPORT SUPERVISOR’S MOTOR DRIVER VEHICLE DATE OF ACCIDENT LOCATION OF ACCIDENT TIME OF ACCIDENT DESCRIPTION OF ACCIDENT: (What happened?) SEAT BELT WORN? CAUSES OF ACCIDENT: (Why did it happen?) RECOMMENDATIONS FOR PREVENTION OF A RECURRENCE: (What should be done?) FOLLOW UP: (What actions were taken? Were they effective?) INDICATE WITH DIAGRAM WHAT HAPPENED CLASSIFICATION OF ACCIDENT REVIEW – SHOW POSITION OF VEHICLES – PREVENTABLE NON-PREVENTABLE INDICATE DIRECTION (NORTH, SOUTH, EAST, – WEST) WITH ARROWS ACCIDENTS USUALLY PREVENTABLE Intersection Cut In or Out Backing Pulled from Curb Hit Other in Rear Hit Stationary Object Skidded Hit Pedestrian ACCIDENTS USUALLY NON-PREVENTABLE Hit in Rear Hit When Properly Parked Reviewed By Manager Date
Appendix D SUPERVISOR’S MOTOR VEHICLE ACCIDENT INVESTIGATION REPORT DRIVER VEHICLE DATE OF ACCIDENT LOCATION OF ACCIDENT TIME OF ACCIDENT DESCRIPTION OF ACCIDENT: (What happened?) SEAT BELT WORN? CAUSES OF ACCIDENT: (Why did it happen?) RECOMMENDATIONS FOR PREVENTION OF A RECURRENCE: (What should be done?) FOLLOW UP: (What actions were taken? Were they effective?) – INDICATE WITH DIAGRAM WHAT HAPPENED – SHOW POSITION OF VEHICLES – INDICATE DIRECTION (NORTH, SOUTH, EAST, WEST) WITH ARROWS CLASSIFICATION OF ACCIDENT REVIEW PREVENTABLE NON-PREVENTABLE ACCIDENTS USUALLY PREVENTABLE Intersection Cut In or Out Backing Pulled from Curb Hit Other in Rear Hit Stationary Object Skidded Hit Pedestrian ACCIDENTS USUALLY NON-PREVENTABLE Hit in Rear Hit When Properly Parked Reviewed By Manager Date