Temecula Police Department - Counter Traffic Collision Report Form Page 3

ADVERTISEMENT

14. Did this collision occur within an intersection? Yes
No
15. Did this collision happen in a parking lot or on private property? Yes
No
16. Your speed:______________________Speed limit (if known):______________
17. Describe the damage to the other vehicle:_________________________________
________________________________________________________________________
18. Was the other vehicle:
Parked
Stopped in traffic
Moving
19. Other driver’s name:__________________________________________________
20. Driver’s license number:_______________________
21. Address:____________________________________________________________
22. Telephone number: (Home)_______________________(Work)_______________
23. Other vehicle’s license plate number:_______________________
24. Other vehicle make, model and color:____________________________________
25. What street was the other vehicle traveling on?____________________________
26. What direction was the other vehicle traveling? (Circle one) North South East
West
27. Other vehicle’s speed:_______________Speed limit (if known)_______________
28. Lighting:
Dawn
Daylight
Dusk (sunset)
Night
29. Weather:
Clear
Raining
Foggy
Other:______________________
30. Provide the names, dates of birth, addresses and telephone numbers of any
passengers in your vehicle:_____________________________________________
31. What were you doing before the collision?________________________________

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go
Page of 5