ACCIDENT
CHECKLIST
CONTENTS
1.
Your Car
·
Vehicle owner:
·
Vehicle driver:
·
Type of car: year, make, standard or automatic, licence number:
·
Passengers (name, address and phone #)
·
Passenger injured?
·
Direction of travel:
·
Speed:
·
Damage to your vehicle:
2.
Other Vehicle
·
Vehicle owner:
·
Details of other driver's insurance:
·
Vehicle driver:
·
Type of car: year, make, standard or automatic, licence number:
·
Passengers (name, address and phone #)
·
Passenger injured?
·
Your impression of the condition of the vehicle (before accident)
·
Headlights on:
·
Wipers:
·
Direction of travel:
·
Speed
·
Damage to vehicle:
3.
The Accident
·
Date, time & Location:
·
Road, traffic and weather conditions:
·
Type of road:
·
Number of lanes:
·
Straight or curved:
·
Intersection type:
·
Pedestrian crossing:
·
Parked cars:
·
Vision obstructions:
·
Lighting and visibility:
·
Speed limit:
·
Factors affecting traffic speed:
·
When did you see the other vehicle?
·
How much time transpired between seeing this vehicle and the
accident occurring?
·
Point of impact:
·
Did vehicles move after impact:
·
What happened to you in the accident (hit body or hit head?)
·
Did you have a chance to prepare for the accident?
·
Your injuries at the scene:
·
Attended by ambulance, fire or police?
·
Did you lose consciousness or feel dizzy or confused?
·
Clothing torn or other property damaged?
·
Were you treated at the scene?
·
Did you have any conversations with anyone at the scene?
·
Did you require help to get out of your vehicle or to get in the
ambulance, etc.?
·
Names, addresses and phone # of witnesses
