Employee Vehicle Accident Report Format
1. Incident Overview
Date of Incident: October 10, 2055
Time of Incident: 2:15 PM
Location: Intersection of Main Street and 5th Avenue, Springfield
Weather Conditions: Overcast, light rain, road surfaces were wet and slippery
2. Employee Details
Name: Floyd Cremin
Position: Delivery Driver
Department: Logistics
Driver's License Number: A123456789
3. Vehicle Details
Vehicle Make and Model: Ford Transit 2050
License Plate Number: XYZ-9876
Company Vehicle ID Number: CVD-4567
4. Description of Incident
The employee, Floyd Cremin, was involved in a vehicular accident on October 10, 2055, at approximately 2:15 PM. Floyd was driving the company vehicle when another car, a 2050 Honda Civic, ran a red light and collided with the right side of the company van. The collision occurred as Floyd was crossing the intersection on a green light. The road was slippery because of light rain, which may have affected braking distances. The Honda Civic sustained damage to its front bumper and fender, while the company vehicle experienced damage to the side door and rear panel. Visibility was limited due to the weather, contributing to the incident.
5. Damages
Type of Damage:
Company vehicle: Right side door dented, rear panel scratched
Honda Civic: Front bumper and left fender crushed
Estimated Repair Cost:
Other Vehicles Involved: 2050 Honda Civic, License Plate: ABC-1234
Impact on Payload: No significant damage to the vehicle's payload, consisting of small, non-fragile packages.
6. Injuries
Employee Injuries: Floyd Cremin experienced mild neck strain but declined immediate medical attention. He later reported to the company clinic for further evaluation.
Other Party Injuries: The driver of the Honda Civic, Jane Smith, reported minor bruising but declined medical treatment on-site.
First Aid or Medical Treatment Administered: Basic first aid (ice pack) was provided to both parties at the scene. No emergency medical services were required.
7. Witnesses
Witness Name: Robert Lee
Contact Information: 222 555 7777
Witness Statement: Robert, who was standing at a nearby bus stop, confirmed that the Honda Civic ran the red light and appeared to be speeding before the collision.
8. Immediate Actions Taken
Authorities Contacted: Local police were contacted, and officers arrived at the scene within 20 minutes. An official police report was filed.
Incident Report Filed with Springfield Police Department, Case ID: SP-2024-6789
On-Site Investigation:
The local police conducted an investigation and took statements from both drivers and witnesses.
The police and the company's fleet management team captured photos of the accident scene for further review.
9. Preventive Measures
In response to the incident, the following preventive measures will be considered to reduce the likelihood of future occurrences:
Review of traffic safety and defensive driving training for all drivers.
Evaluation of company policy regarding driving in adverse weather conditions, including lowering speed limits in wet conditions.
More frequent maintenance checks on braking systems to ensure maximum efficiency during wet weather.
Installation of additional safety cameras in company vehicles to monitor road conditions and driving behavior.
Report Prepared By
Name: [Your Name]
Position: Fleet Manager
Date: October 11, 2055
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