ACCIDENT REPORT 事故报告(英文).docx

ACCIDENT REPORTTo Be Completed at Accident SceneDrivers Name _Plate Number _ GENERAL INSTRUCTIONS1. STOP at the scene as quickly as possible.2. Protect the scene. Use warning devices. Get help from bystanders. Turn off all engines. No smoking. Guard against fire. Check for fuel or cargo leaks.3. Assist injured persons. Dont move them unless absolutely necessary. Summon ambulance if needed.4. Get help. Use near by phone or send reliable passerby. Notify terminal, police and insurance company as instructed. Give location and nature of accident accurately.5. Identify yourself and company. Show license, registration and insurance card on request.6. BE COURTEOUS. Make no statement about accident except to police or company and insurance company representative.7. Fill out and check all applicable information on this form BEFORE YOU LEAVE THE SCENE.A.DATE, TIME, PLACEDate _Time_AM_ PM_In _(City or Town) (County)(State)On_(Street or Highway)At_(Street Address or Intersection)Distance and Direction from:_ Open Country Business-Shopping Residential Manufacturing-Industrial Open (Describe)_YOUR COMPANY NAMED.PEDESTRIAN ACTIONDESCRIBE _Injured?_E.WITNESSPersons seeing the accident will be of service to our driver by giving their names and addresses. NAME_ADDRESS _ Phone_NAME_ADDRESS _ Phone_License number and descriptions of first vehicles at scene._InvestigatingOfficer(s)Name_Badge_ Dept._Police Report# _Name_Badge_ Dept._Citation: You_ Other_Citation: You_ Other_F.ROADWAY CONDITIONS AND CONTROLS Not Divided Divided Limited AccessNo. of Lanes 2 3 4 5 6 _(Specify)Weather _ Condition of roadTime _ Dry Ice Wet Muddy Snow Oily Traffic Smooth OtherB. ACCIDENT SCENEInstructions for Accident DiagramFill dotted lines to correspond with road at accident site. Show position of all vehicles, pedestrians etc. as follows:1Your vehicle2Other vehicle(s)numberedsuccessively.PedestrianTraffic SignalTraffic Sign (indicate type)Your Veh. (#1) _Direction of Travel:Other (#2) _ Not at Intersection Bridge-Overpass Street Intersection Underpass Drive or Alley Private property Crosswalk Other off-street Traffic Control Stop Sign Light Yield Other: _G.PROPERTY DAMAGEDescribe damage to other vehicle: _Describe damage to your vehicle: _Cargo Damage: _Other Property Damage:_I.WHAT HAPPENEDAt what distance did youHow fast were youfirst see danger? _Ft.going? _MPHWhat was your speedHow far did your at impace? _MPHvehicle go after Impact?_Ft.Describe in your own words the circumstances of the accident:_NOTE: This report should be handwritten at scene. Turned into Branch, signed and sent to Fleet Management within 24 hours.Driver_Signature_C.OTHER VEHICLESDriver Veh. #2 _Address_Drivers License No. _OTHER OCCUPANTS:A.Name _ Address _B.Name _ Address _OWNER (IF NOT THE DRIVER):A.Name _Address _VEHICLE:Make & Model _Tag # andState_Insurance Co. _Policy #_INJURIES:Name& Injury_Where taken_Insurance Co. _Policy #_Driver Veh. #3 _Address_Drivers License No. _OTHER OCCUPANTS:A.Name _ Address _B.Name _ Address _OWNER (IF NOT THE DR