In Case Of An Accident

Emergency Checklist

Please print this and keep a copy in your glovebox. It may come in handy when you least expect it.

Stop -- No matter how slight the accident -- and keep calm.

  1. Call the police immediately to report any accident resulting in personal injury or vehicle damage.

  2. Tell police if an ambulance or physician is required for emergency treatment.

  3. Make no admissions and do not take any blame for the accident. Record only facts - not opinions.

  4. Remove hazards from the road. Warn oncoming traffic.

  5. Notify your insurance agent as soon as possible.

Get the names of the witnesses.

Tell them their assistance will be greatly appreciated.

First and Last Name  
 
Address  
 

Telephone
Business  
 
Home  
 
First and Last Name  
 
Address  
 

Telephone
Business  
 
Home  
 

Get details regarding the other vehicle(s).

Car #1

Driver's Name  
 
Liscense Number  
 
Address  
 
Telephone
Business  
 
Home  
 
Liscense Plate Number  
 
Liscense Plate City / State  
 
Car Make / Model / Year  
 
Car Vehicle Identification Number  
 
Name of Insurance Co.  
 
Insurance Agent  
 

Car #2

Driver's Name  
 
Liscense Number  
 
Address  
 
Telephone
Business  
 
Home  
 
Liscense Plate Number  
 
Liscense Plate City / State  
 
Car Make / Model / Year  
 
Car Vehicle Identification Number  
 
Name of Insurance Co.  
 
Insurance Agent  
 

Note the condition of the other vehicle(s), especially any apparent defects.

Note Information On The Injured

Record details of apparent injuries, on-site treatment and method of transportation to the hospital. Write down their:

Name  
 
Address  
 
Age / Sex  
 
Taken To  
 

Record The Details Of The Accident

Date & Time (including am/pm)  
 
Street Location  
 
Speed (Yours and Other's)  
 
Vehicle Damage
Yours  
 
Estimated Cost of Repair  
 
Other's  
 
Estimated Cost of Repair  
 

A walkaround check of your vehicle is a good habit to develop

Draw A Sketch

  1. Take all measurements: skid marks, road widths, etc.

  2. Identify point of impact.

  3. Outline roadway with solid lines. Name all streets and indicate any bridges, overpass, railway crossings.

  4. Mark position of vehicles: 1 for yours, 2, 3, etc. for others.

Emergency Phone Numbers

Police  
 
Fire  
 
Ambulance  
 
Your Doctor  
 
Close Friend or Relative In Case of Severe Emergency  
 

This form furnished couresy of Helms Brothers Body Shop, your DuPont Assurance of Quality Refinisher.