Safety/Accident Policies and Procedures

Incident / Accident Report Packet

Safety Procedure

As required by company policy expects each of the staff, regardless of his/her position within our
organization, to cooperate in every respect with our safety program. Some of the major points of our
program require that:

1. All injuries and accidents are reported immediately to our dispatch department and to obtain medical
aid without delay.
2. Personal protective equipment, where required, must be worn by all staff. There will be no
exceptions to this requirement.
3. Hazardous conditions and other safety concerns must be reported immediately to your supervisor.
4. The staff will follow all safety rules. Failure to follow the rules will result in disciplinary action or
removal from staff.

Accident Policy

1. When there is a staff member or a student injured your first priority is for them to receive medical
help. Apply immediate first aid and if it is serious call 911 for help and continue first aid unit medical
support arrives.

2. Let dispatch know about the accident and explain the details.

3. COMPLETELEY fill out an accident or incident report and include the necessary documentation,
pictures, signatures, witness statements etc.

4. Turn in all your documentation to our dispatch department

This operating procedure applies to the reporting and investigation of all accidents/incidents that result in:

 A work-related injury to any Netcor Transports employee.

 Personal injury to Company personnel while on or using Company owned property; or
 Damage to Company owned property.

Employees are responsible for reporting any injury work-related accident to their manager/supervisor as
soon as possible. All accidents/incidents must be reported by no later than the end of the employee’s
regular work shift.

Accident Scene -- When possible, the accident scene should be preserved and disturbance of any physical
evidence should be prevented until the arrival of law enforcement. Unless necessary to prevent further
damage or injury, clean up or repair activities should commence only after all pertinent information has
been collected.
 Vehicular Accident Report

Drivers Must complete this form before leaving the accident Scene State:
Netcor Transports Information
Date: Time:
Driver: Lic #: DOB:
Unit #: Vin# SS#:
Year Make Veh towed?
Location of Accident:
Closest Intersection:
Netcor Vehicle Damage:

Signal Light (Red, Yellow, Green) Speed of Netcor Vehicle:

Road Cond. (Dry, Snow, wet, Icy, etc.) Speed of Vehicle # 1:
Wheather Cond.( Sunny, Rain, Fog etc.) Day Cond. (Day, Dusk, Night,etc.)
Other Driver (Vehicle#1)
Driver's Name: DL#: State:
Address: City: Zip:
Home Phone: ( ) Work Ph: ( )
Vehicle Owner's Name: Licence Plate:
Address: City: Zip:
Home Phone: ( ) Work Ph: ( )
Year: Make: Model:
Describe Vehicle Damage: Towed?
Odometer:

Insurance Carrier: Policy#:

Carrier Address: Phone:

Name of Passenger #1: Phone:

Address:
Name of Passenger #2: Phone:
Address:
Police Information
Office Name: Badge #: Report#
Police Department: Was Anyone Cited of Arrested?
if Yes What are the Charges?
Witness information
Witness #1 Name: Phone: ( )
Witness #2 Name: Phone: ( )
Witness #3 Name: Phone: ( )
Page 1 of 2
 Passengers of Netcor Transports Vehicle
Name: Phone: ( )
Address: City: State:
Name: Phone: ( )
Address: City: State:
Name: Phone: ( )
Address: City: State:
Injuries
Name: Age: Sex: Vehicle:
Address: City: State
Injury (describe): Which hospital:
Name: Age: Sex: Vehicle:
Address: City: State
Injury (describe): Which hospital:
Name: Age: Sex: Vehicle:
Address: City: State
Injury (describe): Which hospital:
Accident Description
Explain in your own words what happened (be Thorough):

Diagram of Inccident
Draw a Diagram of the inccident. Be sure to show the position of all vehicles and pedestrians
the point of collission, the path of vehicles after collision, stop signs, traffic signals, and
the names of streets, roads etc.

Accident Photos
Netcor Unit: Front Back Sides Full Scene
Circle all Completed
Other Veh: Front Back Sides
Driver signature
Driver signature: Date:
Page 2 of 2
 Non Vehicular Incident / Accident Report

Date of Inci dent/Acci dent: _____________________________

Empl oyee Name: _____________________________________

Client name: ____________________________ Contact Number:__________________________

Witnesses: ______________________________ Contact Number:_________________________

Date of i nci dent report: ___________________ Ti me inci dent was reported: _______________

Location of inci dent: _________________________________ __________________________________________

Cause of inci dent: _____________________________________________________________________________

Descripti on of inci dent: (Be Thorough)

_____________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_______________________________________________________________________________ ______________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Outcome of inci dent:
___________________________________________________________________________ __________________
_______________________________________________ ______________________________________________
_____________________________________________________________________________________________
Injuries and damage to company personnel:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Damage to company equi pment: _________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Injuries and damage to client:
______________________________________________________________________________ _______________

The undersigned hereby acknowledges that all information wi thin this brief is, to the best of their ability, true
and accurate as was witnessed and observed by the undersigned.

Signature and title of empl oyee: ______________________________ Date: _____________________________

Supervisor signature: _______________________________________ Date: _____________________________