Accident Checklist

Print the following Information Checklist and keep it in your car in case you have a collision.

Use a diagram of an intersection to map out the accident:

License plate # of other car: ______________________________________________________

Make and year: ______________________________________________________

Driver of other car: ______________________________________________________

Driver's License No.: ______________________________________________________

Address: ______________________________________________________

Phone number: ______________________________________________________

Insured by: ______________________________________________________

Owner of other car: ______________________________________________________

Address: ______________________________________________________

Phone number: ______________________________________________________

Insured by: ______________________________________________________

Witnesses (including occupants of both cars): ______________________________________________________

Name: ______________________________________________________

Address: ______________________________________________________

Phone number: ______________________________________________________

Car type: ______________________________________________________

License plate #: ______________________________________________________

Name: ______________________________________________________

Address: ______________________________________________________

Phone number: ______________________________________________________

Car type: ______________________________________________________

License plate #: ______________________________________________________

Date of collision: ______________________________________________________

Time: Location: ______________________________________________________

Police officer: ______________________________________________________

Damage to other vehicle: ______________________________________________________