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____________________________________________________________