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Incidents Commonly Reported
- Mechanical or equipment issues (e.g., blown tires, brake failure)
- Stolen cargo or damaged freight
- Traffic accidents caused by the driver or others
- Citations issued by police or transportation officials
Hazardous Materials
Within 30 days of an accident involving hazardous materials, a Hazardous Materials Incident Report must be completed and submitted to the Department of Transportation (DOT).[1]
Immediate Notification – Incidents resulting in death or other serious outcomes must be reported immediately to the National Response Center by phone at (800) 424-8802.[2]
Sample
Full Name: [DRIVER NAME] Driver’s License No.: [DL NO.]
Address: [DRIVER ADDRESS] Phone: [PHONE]
Company / Employer: [COMPANY / EMPLOYER NAME] Employee No.: [EMPLOYEE NO.]
Truck Fleet / Registration No.: [TRUCK FLEET (IF ANY) AND REG. NO.]
Trailer Fleet / Registration No.: [TRAILER FLEET (IF ANY) AND REG. NO.]
Signature: Date: [MM/DD/YYYY]
INCIDENT DETAILS
Date of Incident: [MM/DD/YYYY] Time: [TIME] ☐ AM ☐ PM
Incident Type: ☐ Collision ☐ Injury ☐ Equipment Failure ☐ Cargo Spill
☐ Interaction / Conflict ☐ Customer Complaint ☐ Other: [OTHER]
Location: [INCIDENT LOCATION]
Describe the Incident: [DESCRIBE INCIDENT]
Truck Towed? ☐ Yes ☐ No | If yes, specify towing company: [COMPANY NAME]
OTHER PARTIES INVOLVED
- Full Name: [NAME] Phone: [PHONE] E-Mail: [E-MAIL]
Address: [ADDRESS]
Identification: ☐ Driver’s License No.: [DL NO.] ☐ Other.: [OTHER NO.] - Full Name: [NAME] Phone: [PHONE] E-Mail: [E-MAIL]
Address: [ADDRESS]
Identification: ☐ Driver’s License No.: [DL NO.] ☐ Other: [OTHER NO.] - Full Name: [NAME] Phone: [PHONE] E-Mail: [E-MAIL]
Address: [ADDRESS]
Identification: ☐ Driver’s License No.: [DL NO.] ☐ Other: [OTHER NO.]
INJURIES / DAMAGE
Was anyone injured? ☐ Yes ☐ No
If yes, describe the injuries: [DESCRIBE INJURIES]
Was there damage to any equipment/property? ☐ Yes ☐ No
If yes, describe the damage: [DESCRIBE DAMAGE]
WITNESSES
Were there witnesses to the incident? ☐ Yes ☐ No
If yes, enter the witnesses’ names and contact info:
- Full Name: [NAME] Phone: [PHONE] E-Mail: [E-MAIL]
- Full Name: [NAME] Phone: [PHONE] E-Mail: [E-MAIL]
- Full Name: [NAME] Phone: [PHONE] E-Mail: [E-MAIL]
POLICE / MEDICAL SERVICES
Police Notified? ☐ Yes ☐ No | If yes, was a report filed? ☐ Yes ☐ No
Was medical treatment provided? ☐ Yes ☐ No ☐ Refused
If yes, where was medical treatment provided? ☐ On site ☐ Hospital ☐ Other: [SPECIFY]