Drivers Collison Report: Trucking
This report is to be completed after the collision by the driver
Collision Information
Accident Date
-
Month
-
Day
Year
Date
Accident Time
Location - Specify street name, nearest intersection, and/or landmark(s)
City
Province/State
Name
First Name
Last Name
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Soundbox Vehicle Information
Year
Make
Colour
VIN
Unit number
Were you pulling a trailer?
Yes
No
Trailer Information
Year
Make
VIN
Number of trailers
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Soundbox Driver Information
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Driver's License Number
Expiration Date
-
Month
-
Day
Year
Date
Province/State of Issue
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Incident Information
How Many Vehicles were involved?
How Many Vehicles were damaged?
Was the cargo damaged?
Yes
No
What direction were you traveling?
How fast were you traveling? - km/h
Were your headlights on when the collision occurred?
Yes
No
What lane were you in? (lane closest to the shoulder is Lane 1)
How many lanes wide is the road in one direction?
Were warning signals given prior to the collision occurring?
Yes
No
If yes, what was the signal given and by whom?
Involved Vehicle Information 1
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Driver's License Number
Expiration Date
-
Month
-
Day
Year
Date
Province/State of Issue
Vehicle Type
Vehicle Plate
Insurance Policy Name
Insurance Policy Number
Insurance Policy Expiration Date
-
Month
-
Day
Year
Date
Number of People in the Vehicle
Was anyone injured?
Vehicle Actions
Driving straight ahead
Turning right
Turning left
Making a U-turn
Lost control
Stopped or parked
Backing up
Jack-knifed trailer
Passing right side
Passing left side
Weaving
Skidding
On the wrong side
Other issue(s) (Please specify below)
Other issue(s)
Involved Vehicle Information 2
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Driver's License Number
Expiration Date
-
Month
-
Day
Year
Date
Province/State of Issue
Vehicle Type
Vehicle Plate
Insurance Policy Name
Insurance Policy Number
Insurance Policy Expiration Date
-
Month
-
Day
Year
Date
Number of People in the Vehicle
Was anyone injured?
Vehicle Actions
Driving straight ahead
Turning right
Turning left
Making a U-turn
Lost control
Stopped or parked
Backing up
Jack-knifed trailer
Passing right side
Passing left side
Weaving
Skidding
On the wrong side
Other issue(s) (Please specify below)
Other issue(s)
Involved Vehicle Information 3
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Driver's License Number
Expiration Date
-
Month
-
Day
Year
Date
Province/State of Issue
Vehicle Type
Vehicle Plate
Insurance Policy Name
Insurance Policy Number
Insurance Policy Expiration Date
-
Month
-
Day
Year
Date
Number of People in the Vehicle
Was anyone injured?
Vehicle Actions
Driving straight ahead
Turning right
Turning left
Making a U-turn
Lost control
Stopped or parked
Backing up
Jack-knifed trailer
Passing right side
Passing left side
Weaving
Skidding
On the wrong side
Other issue(s) (Please specify below)
Other issue(s)
Involved Vehicle Information 4
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Driver's License Number
Expiration Date
-
Month
-
Day
Year
Date
Province/State of Issue
Vehicle Type
Vehicle Plate
Insurance Policy Name
Insurance Policy Number
Insurance Policy Expiration Date
-
Month
-
Day
Year
Date
Number of People in the Vehicle
Was anyone injured?
Vehicle Actions
Driving straight ahead
Turning right
Turning left
Making a U-turn
Lost control
Stopped or parked
Backing up
Jack-knifed trailer
Passing right side
Passing left side
Weaving
Skidding
On the wrong side
Other issue(s) (Please specify below)
Other issue(s)
Involved Vehicle Information 5
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Driver's License Number
Expiration Date
-
Month
-
Day
Year
Date
Province/State of Issue
Vehicle Type
Vehicle Plate
Insurance Policy Name
Insurance Policy Number
Insurance Policy Expiration Date
-
Month
-
Day
Year
Date
Number of People in the Vehicle
Vehicle Actions
Driving straight ahead
Turning right
Turning left
Making a U-turn
Lost control
Stopped or parked
Backing up
Jack-knifed trailer
Passing right side
Passing left side
Weaving
Skidding
On the wrong side
Other issue(s) (Please specify below)
Other issue(s)
Was anyone injured?
Witness information
How many witnesses were involved?
Witness 1 name
First Name
Last Name
Witness 1 Contact number
Please enter a valid phone number.
Format: (000) 000-0000.
Witness 1 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Witness 2 name
First Name
Last Name
Witness 2 Contact number
Please enter a valid phone number.
Format: (000) 000-0000.
Witness 2 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Witness 3 name
First Name
Last Name
Witness 3 Contact number
Please enter a valid phone number.
Format: (000) 000-0000.
Witness 3 Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Road/weather conditions
Describe the road conditions by checking one or more of the following:
Straight
Level
Curve
Marked lanes
Unmarked lanes
Grade % (Please specify below)
Hilly
Debris/construction
Pot holes
Hill crest
Divided highway
Oily
Snowy
Wet
Dry
Icy
Muddy
Other issues(s) (Please specify below)
Grade %
Other issue(s)
Describe the traffic controls at the intersection by checking one or more of the following
Four-way stop
Four-way traffic lights
Stop signs at north/south sides
Stop signs at west/east sides
Traffic lights at north/south sides
Traffic lights at west/east sides
Other issue(s) (Please specify below)
Other issue(s)
Describe the traffic conditions just prior to the collision by checking one or more of the following
None
Heavy
Light
Stop & go
Merging traffic
Other issue(s) (Please specify below)
Other issue(s)
Describe the weather conditions just prior to the collision by checking one or more of the following
Clear
Snow
Fog
Rain
Other issue(s) (Please specify below)
Other issue(s)
Describe the visibility just prior to the collision by checking one or more of the following
Daylight
Darkness
Artificial Light
Dusk
Other issue(s) (Please specify below)
Other issue(s)
Describe how the collision occurred. Please describe all the details of the collision.
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Police information
Were the police present at the collision
Yes
No
Officer 1 name
Officer 1 badge number
Officer 2 name
Officer 2 badge number
Name of police agency
Police phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Report number
Was anyone arrested?
Yes
No
Name of person arrested
First Name
Last Name
Were any tickets issued?
Yes
No
If so, to whom and for what offense?
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Supporting Details
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