Accident Incident Report Form

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Accident Incident Report Form

An accident incident report records the details of an accident that resulted in personal injury or property damage. It ensures that the who, what, where, when, and how questions of an accident get answered and documented for further investigation. It’s generally standard procedure to complete the form within 24 hours of the incident occurring.

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Last updated August 21st, 2025

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An accident incident report records the details of an accident that resulted in personal injury or property damage. It ensures that the who, what, where, when, and how questions of an accident get answered and documented for further investigation. It’s generally standard procedure to complete the form within 24 hours of the incident occurring.

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Document Features

  • Incident Details – When and where the incident occurred, what happened, and a timeline of events.
  • Parties Involved – A list of all parties involved and their contact information.
  • Injuries – A description of any injuries that were sustained and by whom.
  • Witnesses – The names and contact info of any witnesses to the incident.
  • Police/Medical Services – Whether emergency services were called and required.

Sample

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ACCIDENT INCIDENT REPORT FORM
INDIVIDUAL FILING REPORT

Full Name: [FULL NAME] Title/Role: [TITLE/ROLE]
Signature:                                                           Date: [MM/DD/YYYY]

INCIDENT DETAILS
Date of Incident: [DATE OF INCIDENT]      Time: [TIME] ☐ AM ☐ PM

Location: [LOCATION]

Describe the Incident: [DESCRIBE THE INCIDENT]

PARTIES INVOLVED
Full Name: [FULL NAME] Phone: [PHONE] E-Mail: [EMAIL] Address: [ADDRESS]
Identification: ☐ Driver’s License No. [DL NUMBER] ☐ Passport No. [PASSPORT NUMBER] ☐ Other: [OTHER]

Full Name: [FULL NAME] Phone: [PHONE] E-Mail: [EMAIL] Address: [ADDRESS]
Identification: ☐ Driver’s License No. [DL NUMBER] ☐ Passport No. [PASSPORT NUMBER] ☐ Other: [OTHER]

INJURIES
Was anyone injured? ☐ Yes ☐ No

If yes, describe the injuries: [INJURY DESCRIPTION]

WITNESSES
Were there witnesses to the incident? ☐ Yes ☐ No

If yes, enter the witnesses’ names and contact info:

  1. Full Name: [FULL NAME] Phone: [PHONE] E-Mail: [EMAIL]
  2. Full Name: [FULL NAME] Phone: [PHONE] E-Mail: [EMAIL]

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: [OTHER]