Drivers Vehicle Accident Test - Thompson Electric, Inc.

Driver's Report of Motor Vehicle Accident

Report to the Fleet Manager and your supervisor immediately; then, complete as much of the report as possible.

Date

Where Accident Occurred

At Intersection With:

If not at intersection:

Nearest highway, street, bridge, or other landmark:

When did accident occur?

Date

Number of vehicles involved:

Name of police department:

Police Report Number:

Police Offer Business Card:

Max. file size: 32 MB.

Vehicle #1 - Driver's TEI Vehicle

Immediate Supervisor

Driver's Name (Last, First, Middle)

Vehicle #2 and/or Other Party

Please upload insurance card here:

Max. file size: 32 MB.

The preferred method is to take a photo of the other parties insurance card. If you are unable to take a photo complete the following:

Insurance Company Name

Insurance Company Address

Insurance Effective Dates

Insurance Expiration Dates

Vehicle Identification Number (VIN)

List Citation(s) if Available to you

Vehicle Damage Location Indicator

Please indicate on the image below where the damage on the vehicles was sustained by clicking on the diagram. Re-click a circle if you would like to remove it.

Passenger(s)/Independent Witness

Complete to the best of your knowledge.

Vehicle number as described in report:

Damaged Customer Property:

Please describe:

Other Damaged Property:

Please describe:

Other Comments/Additional Vehicles/Passengers/Witnesses:

Vehicle Accident

Driver's Report of Motor Vehicle Accident

Where Accident Occurred

If not at intersection:

When did accident occur?

Vehicle #1 - Driver's TEI Vehicle

Vehicle #2 and/or Other Party

Vehicle Damage Location Indicator

Passenger(s)/Independent Witness

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