More examples in Forms/Medical & Injury Forms
Car Accident Checklist with Personal Injury Example
SmartDraw includes thousands of professional-looking diagrams like this that you can easily edit and make your own.
Text in this example:
Description of the Accident Description of the accident: Date of the accident: Time: am/pm Day of week: Location: Direction in which each car was traveling: Car Accident Checklist Parties Involved Names, Addresses, and phone number of driver of each car: Names, Addresses, and phone number of owner of each car: Names, Addresses, and phone number of passengers in each car: Names, Addresses, and phone number of all witnesses: Area Around the Accident Number of lanes of each street: One way or two way: Condition of roadways: Slope of each street: Photographs of the scene: Amount of traffic: Traffic controls: (lights, stop signs, etc.) Vehicle Descriptions Speed of each vehicle at the time of impact and just before impact: at the time of impact just before impact at the time of impact just before impact Length of any skid marks: Use of brakes by each vehicle: Use of horn by each vehicle: Use of turn signals by each vehicle: Point of impact on each car: Movement of each car upon impact: Final position of each vehicle: License plate number of each vehicles: Location of your car now: Date the car was purchased: Trip Place where the trip began: Destination: Purpose of the trip: Scheduled arrival time: Photographs of damage to each car: Damage done to the vehicles: Years, makes, and models: Driver's license numbers: Conditions Lighting conditions: Weather: Position of the sun: Use of: sunglasses glasses/contact lenses defroster car phones Radio/car stereo windshield wipers alcohol/drugs by any passenger or driver Windows open or closed: Driver smoking, eating, or drinking at the time of the accident: Seat belt: Stick shift or automatic transmission: Date of last eye examination: Name and address of eye doctor: Injuries Movement of your body at the moment of impact: What part of you body came into contact with the vehicle: Pain at the moment of impact: Name of your auto insurance company: Policy number: Coverages: Name of other auto insurance in your household: Policy number: Coverages: