Car Accident Report Form

July 12, 2011

Car accidents are usually very frustrating situations. A car accident report form is designed to establish
important details regarding the car accident. The car accident report form is used to gather relevant and
essential information about the car accident, the damage caused, who was involved along with other
vital details.
Sample Car Accident Report Form

Date ………………………………….
Time of Accident ………………………………………..
Location of Accident ……………………………………….
Condition of Road ……………………………………………
Climatic Conditions …………………………………………..
Speed …………………………………………………
Direction ………………………………………………..
License Plate Number ……………………………………….
Car Model ………………………………………..
Driver’s Name ……………………………………….
Age ……………………………………………………….
Telephone Number ……………………………………………
Address ……………………………………………….
Had the driver consumed any alcoholic beverage prior to driving?
……………………………………………………………………………
Who caused the accident?
…………………………………………………………………………..
Passenger’s Name ………………………………………….
Details of Other Driver
Name …………………………………………………………
Age ………………………………………………………………
Telephone Number ………………………………….
Address ……………………………………………….
License Number …………………………………………
Name of Insurance Company ……………………………………….
Name of Agent ………………………………………………
Police Department ……………………………………
Name of Police Officer ……………………………………….
Report Number ……………………………………………….
Details of Accident
……………………………………………………………………………..
………………………………………………………………………………
…………………………………………………………………………………..
Other Comments …………………………………………………..