Car Accident Checklist - Injury Report

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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
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: