Accident Report Template
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1
2When you are in an accident
Fill this in as soon after the accident as you can to help you make your report.
Time
Date
Weather
Light
(dawn, dusk, dark, day)
The Highway Traffic Act
requires the driver of a vehicle involved in an accident to give written information to
anyone who was injured or whose property was damaged.
Other driver
Vehicle
Name
Address
(year and make)
Telephone (daytime)
Vehicle
Telephone (evening)
(body type: sedan, hatchback, etc.)
Vehicle owner’s name
Licence plate #
(if
not
the
driver)
(Province/State)
Vehicle owner’s address
Expiration
Insurance company
Driver’s licence #
Policy #
Expiration
Insurance agent
Address
The Accident
What happened? Describe damage to vehicles and
Diagram
property
D – Driver
1 – Other party
2 – Other party
What injuries did people have?
Complete this diagram using
arrows to indicate direction of vehicles that collided and
location at point of contact
Witnesses
Name
Name
Address
Address
Telephone (daytime)
Telephone (daytime)
Telephone (evening)
Telephone (evening)
Police
Report to the police within seven days if the collision
You do NOT have to report to police if only property
involves:
damage was sustained, no matter the value of the
fatality
damage.
•
serious injury (meaning someone was hospitalized)
•
unlicensed driver or unregistered vehicle
•
Police officer’s name and/or badge number
unidentified vehicle (e.g. hit and run)
•
failure to obtain particulars from the other party
•
Police File #
Detachment telephone
suspected use of drugs or alcohol by the other driver
•
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