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Fall-Down Accident Personal Injury Checklist Example
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Text in this example:
Description of the Accident Description of the accident: Names, addresses, and phone numbers of all witnesses: Date of the accident: Time: am/pm Day of week: Location: Location of the accident:: Condition of the accident area (e.g. sidewalk); Photographs of the scene: Place where the trip began: Destination: Purpose of the trip: Scheduled arrival time: Fall-Down Accident Checklist Conditions Surrounding the Accident Smoking, eating, or drinking at the time of the accident: Date of last eye examination: Name and address of the eye doctor: Use of headphones: Lightning conditions: Weather: Position of the sun: Use of sunglasses: Use of alcohol/drugs: Object carried at time of accident: Type and condition of shoes: All conversation at the scene: Police Involvement Police district involved: Name and badge number of attending officer: Injury What happened to your body as you fell: What part of you body came into contact with the ground: How did you feel immediately after you fell: Name of health insurance company: Policy number: Coverages: