Traffic Accident Report Form - Thomas P Cotrel, Attorney at Law

Thomas P. Cotrel, Attorney at Law
(818)841-4650, 927A W Olive Ave, Burbank, CA 91506
[Main page] [ Accident Advice]
Print this form and save in your car.

Traffic Accident Report

Name of Driver:____________________________________________________________________________________
License No:___________________________ Make of Vehicle:_____________________ Type:_________________

TIME AND
PLACE Date and time of accident:_________________________________________________________________________
Location (address or intersection):________________________________________________________________
City and state:____________________________________________________________________________________
DAMAGE TO
OUR VEHICLE Describe damage to our vehicle:____________________________________________________________________
___________________________________________________________________________________________________
OTHER CAR
AND OTHER
PROPERTY
DAMAGED License #:___________________________ Make of vehicle:_____________________
Type:_____________________ Name of insurer/policy #:______________________________________________
Name/address of owner:
_________________________________________________________________________
Name/address of driver:
________________________________________________________________________
Driver license no/state of driver:
_________________________________________________________
Describe damage to vehicle and/or other property:
___________________________________________________________________________________________________
INJURED
PERSONS Name:_____________________________________________________________
dob/age:________________________
Address:___________________________________________________________________________________________
Nature of injury:_________________________________________________
Taken to hospital? Yes___ No ___

POLICE
AND
EMERGENCY Name and address of any police agency at scene:
________________________________________________________________
________________________________________________________________
Name of officer:______________________
Report no:_____________
Name and address of any paramedics/emergency personnel at scene:
___________________________________________________________________________
___________________________________________________________________________
Report no:_____________

WITNESSES Name, address, telephone number and other contact info on all witnesses:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________
___________________________________________________________________________________________________

Describe how accident happened:
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
Diagram

Name of Driver:____________________________________________________________________________________ License No:___________________________ Make of Vehicle:_____________________ Type:_________________
TIME AND PLACE	Date and time of accident:_________________________________________________________________________ Location (address or intersection):________________________________________________________________ City and state:____________________________________________________________________________________
DAMAGE TO OUR VEHICLE	Describe damage to our vehicle:____________________________________________________________________ ___________________________________________________________________________________________________
OTHER CAR AND OTHER PROPERTY DAMAGED	License #:___________________________ Make of vehicle:_____________________ Type:_____________________ Name of insurer/policy #:______________________________________________ Name/address of owner: _________________________________________________________________________ Name/address of driver: ________________________________________________________________________ Driver license no/state of driver: _________________________________________________________ Describe damage to vehicle and/or other property: ___________________________________________________________________________________________________
INJURED PERSONS	Name:_____________________________________________________________ dob/age:________________________ Address:___________________________________________________________________________________________ Nature of injury:_________________________________________________ Taken to hospital? Yes___ No ___
POLICE AND EMERGENCY	Name and address of any police agency at scene: ________________________________________________________________ ________________________________________________________________ Name of officer:______________________ Report no:_____________ Name and address of any paramedics/emergency personnel at scene: ___________________________________________________________________________ ___________________________________________________________________________ Report no:_____________