Company Vehicle Accident Report Forms Exhibit 9-12

COMPANY VEHICLE
ACCIDENT REPORT

IT IS ABSOLUTELY NECESSARY THAT YOU OBSERVE THE FOLLOWING

PROCEDURES COMPLETELY WHEN YOU ARE INVOLVED IN AN ACCIDENT INVOLVING
A COMPANY VEHICLE (CAR OR TRUCK).

1. If you are involved in an accident involving a company vehicle, you must stop. Failure
to stop allows you to be subject to criminal prosecution. Leave your vehicle as close as
possible to the scene of the accident without obstructing traffic.

2. If someone is injured and you are qualified to give first aid, do so. However, you must
also call the police and/or rescue team as soon as possible.

3. Make sure your vehicle is not obstructing traffic. If the vehicle cannot be moved, raise
the hood and put your vehicle’s hazard warning lights on. If you have flares or reflectors
available, use them.

4. Once the police have arrived, ask the police officer how you can get a copy of the
accident report. Make sure you get the police officer’s name and badge number.
Remember, you are not guilty until it is proven that you are guilty. Do not admit fault,
even if the officer gives you a ticket.

5. Make sure you exchange information with the driver of the other vehicle. See the
attached Accident Information Form.

6. As soon as possible, call the company to inform a manager (i.e.: Human Resource
Director, Operations Manager, General Manager, Office Manager, Controller, or other
management member) that you have been in an accident (and to receive instructions as
to what to do next in reference to your vehicle, if it is not driveable). If your vehicle
requires towing, indicate to the police officer where you wish it to be towed, per
instructions from the company.

7. Make sure that you file an accident report with Human Resources. This is a legal
requirement.

ACCIDENT INFORMATION
Company Vehicle Accident Report Forms Exhibit 9-12 (continued)

Employee name:

Accident date/time:

Location of accident:

Road conditions:

Traffic conditions:

Weather conditions:

Police officer name/badge number:

Ticket issued? Yes No If yes, to whom?

What charge?

Explain in your own words what occurred:

In the space below, please draw a diagram of the accident as you remember it. Please be
specific, indicating stop signs/lights, etc. Include any information that you feel might be helpful.

In the space below, please list any visible damage to the other vehicle:
Company Vehicle Accident Report Forms Exhibit 9-12 (continued)

Other Driver/Vehicle Information:

Name:
Address:

Phone No.:
Drivers License No.:
Insurance Co.:
Policy No.:
License Plate No.:
Vehicle Make, Model, Year:
Any apparent injuries?
Are they claiming any injuries?
Is the driver also the registered owner of the vehicle? Yes No
If not, please list name, phone number and address of the owner:

Other Vehicle Passengers:

Name(s):

Address/Phone:

Witnesses:
Name(s):

Address/Phone: