Bard Accident Report

Accident Report Form

BARD COLLEGE

AUTOMOBILE ACCIDENT REPORT Page 1

COPIES OF THIS COMPLETED REPORT MUST BE GIVEN TO THE TRANSPORTATION OFFICE WITHIN 24 HOURS OF INCIDENT

Please complete the following, in pen, using additional sheets and attachments where needed.

THE ACCIDENT:

Date of Accident _____/_____/______ Time: ___________a.m. ___p.m.___

Location of Accident:  (Street or Intersection/City/State)______________________________________________

VEHICLE 1:

Year_____ Make____ Model ___________ VIN _____________________________ License Plate # ___________

Vehicle 2: Name of Insurance Company_________________________Policy #_____________________________

Name/Phone # of the Vehicle 1 Driver______________________________________________________________

Was Driver 1driving a Bard-owned vehicle at the time of accident? Y ____N____ Department? ________________

Was Driver 1 driving with Bard’s permission? Y_____ N_____ If no, what was Driver 1 doing at the time of  the accident?  ____________________________________________________________________________________

Were there any passengers in Vehicle 1?  Y____ N ____ if yes, provide all names and telephone numbers below:

_____________________________________________________________________________________________

Was anyone in Vehicle 1 injured? Y____ N ___If Yes, Name & Telephone ________________________________

Was anyone in Vehicle 1 taken to the hospital? ? Y____ N ___ If so, provide any known details on separate sheet.

Were the Police Called? Y_____N_____ Name of responding Police Department?___________________________

Was a Police Report filed? Y____ N____ Officer’s Name_______________________________________________

Was Driver 1 ticketed? Y_____ N_____ f yes, please give details________________________________________

Please describe damage to Vehicle 1________________________________________________________________

Where is Vehicle 1 now?_______________________________________________________________________

Did you obtain an estimate of damages? Y____ N___ Damage Estimate $___________ From Who?____________ (Please attach any supporting documentation)

 

 

 

BARD COLLEGE

AUTOMOBILE ACCIDENT REPORT Page 2

VEHICLE 2:

Were there any other vehicles involved in the accident?  Y____ N ____  Please provide the following information for each vehicle.  Use separate sheet for each additional vehicle.

Year_____ Make____ Model ___________ VIN _____________________________ License Plate # ___________

Name/Address/Telephone No. of Owner: ____________________________________________________________________________________________

Name/Address/Telephone No. of Driver, if other than Owner:___________________________________________

____________________________________________________________________________________________

Vehicle 2: Name of Insurance Company_________________________Policy #_____________________________

If Vehicle 2 was parked, was it occupied? Y_____ N_____ Name/Address/Telephone # of occupant(s): _____________________________________________________________________________________________

Was anyone in Vehicle 2 injured? Y____ N ___For any known or apparent injuries, please provide details, including, but not limited to the Name, Address, Phone No. of injured parties and known extent of injuries: __________________________________________________________________________________________________________________________________________________________________________________________

Was anyone in Vehicle 2 taken to the hospital? Y____ N ___ If so, provide any known details on separate sheet.

Were there any known fatalities? Y _____ N_____

Were there any witnesses?  Y ______ N ______ Please provide Name/Address/Telephone Number of each witness. __________________________________________________________________________________________________________________________________________________________________________________________

With as much detail as possible, please describe accident (use separate sheet, if necessary): _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Signature of individual completing form                                                                                        Date        /        /                      Print Name of individual filing out form____________________________________________________________