VEHICLE WRECK/ACCIDENT REPORT

VEHICLE ACCIDENT REPORT
YOU ARE OUR BEST DEFENSE!

GET AS MUCH INFORMATION AS POSSIBLE.
STOP WITNESSES AND GET THEIR CONTACT INFO BEFORE THEY LEAVE... ESPECIALLY IF YOU ARE AT FAULT!

GET THE WITNESSES NAME AND PHONE NUMBER BEFORE THEY LEAVE, SO WE CAN CALL THEM AND GET A STATEMENT IF NECESSARY
POSITION YOUR TRUCK SO THE DASH CAMERA CAPTURES ALL OF THE POST-INCIDENT INTERACTIONS.

After the accident, leave the truck on and park so that you capture all interactions with the other parties on the dash camera. We want video of them walking around and video proof of the extent of their injuries (if any).
GET PICTURES AND VIDEOS
TAKE PICTURES OF THE FOLLOWING:
- P&S VEHICLE DAMAGE
- OTHER VEHICLE DAMAGE
- OTHER DRIVER'S LICENSE
- OTHER DRIVER'S INSURANCE CARD
- THE ACCIDENT SCENE
- THE POLICE REPORT
- THE TICKETS ISSUED
TAKE VIDEOS OF THE FOLLOWING:
- THE ACCIDENT SCENE
- THE VEHICLE DAMAGE
- ANY INTERACTIONS WITH THE OTHER PARTIES
- ANY "IT WAS MY FAULT" STATEMENTS FROM THE OTHER PARTY
- ANY "I AM OKAY" STATEMENTS
- THE OTHER PARTY AFTER THE ACCIDENT
- P&S VEHICLE DAMAGE
- OTHER VEHICLE DAMAGE
SEND ALL INFORMATION, PHOTOS, VIDEOS, DOCUMENTS TO JOSEPH

EMAIL TO: JOSEPH@PFEIFFERANDSON.COM

OR

TEXT TO: 281-467-8976
NOTIFICATION PROCESS
- CALL JOSEPH (281)467-8976
  - If you cannot reach Joseph, contact one of the following:
    
    Carolina Almendarez: (346) 602-9312
    
    Carter Samford: (281) 799-3054
    
    Sean McCabe: (346) 263-7135
DO NOT CALL THE POLICE UNTIL DISCUSSING WITH JOSEPH (OR ONE OF THE OTHER CONTACTS ABOVE)
DATE OF INCIDENT*

MonthDayYearHourMinutesAM/PM Option
VEHICLE*
DRIVER OF THE PFEIFFER & SON VEHICLE*

First NameLast Name
OTHER P&S UNITS INVOLVED (I.E. TRAILERS, EXCAVATORS, ETC.)
LOCATION OF ACCIDENT
NEAREST KNOWN ADDRESS

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
NEAREST INTERSECTION
Address Map Locator
ACCIDENT INFORMATION
EXPLANATION OF THE INCIDENT*
TYPE OF ACCIDENT*
WORK ZONE FLASHERS AND BEACON ACTIVATED*
WEATHER*
ROADWAY CHARACTER*
LIGHT CONDITIONS*
TRAFFIC CONTROL*
ROAD SURFACE*
TRAFFIC CONDITIONS*
PRE-ACCIDENT VEHICLE ACTION (P&S VEHICLE)*
WHAT WERE YOU DOING RIGHT BEFORE THE ACCIDENT
PRE-ACCIDENT VEHICLE ACTION (VEH. 2)*
WHAT WERE WAS THE OTHER DRIVER DOING RIGHT BEFORE THE ACCIDENT
DESCRIBE THE DAMAGE TO THE P&S VEHICLE(S)
PASSENGER NAME
INJURED?
BRIEFLY DESCRIBE INJURIES
PASSENGER NAME
INJURED?
BRIEFLY DESCRIBE INJURIES
PASSENGER NAME
INJURED?
BRIEFLY DESCRIBE INJURIES
OTHER PERSONS PERSONAL AND VEHICLE INFORMATION

(DRIVER OF VEHICLE #2)
LIC. PLATE NUMBER
YEAR
MAKE/MODEL
VIN
DRIVERS NAME

First NameLast Name
Birth Date

MonthDayYear
DRIVERS LIC #
LIC STATE
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Insurance Company
Policy Number
DESCRIBE THE DAMAGE TO THE OTHER VEHICLE(S)
PASSENGER NAME
INJURED?
BRIEFLY DESCRIBE INJURIES
PASSENGER NAME
INJURED?
BRIEFLY DESCRIBE INJURIES
PASSENGER NAME
INJURED?
BRIEFLY DESCRIBE INJURIES
POLICE INVESTIGATION
WAS THERE A POLICE INVESTIGATION*
POLICE DEPARTMENT
CASE #
PHONE NUMBER TO CALL TO GET REPORT

Area CodePhone Number
WERE YOU ISSUED A TICKET OR CITATION*
WHAT WERE YOU TICKED FOR?
WAS THE OTHER DRIVER ISSUED A TICKET OR CITATION*
WHAT WAS THEIR TICKED FOR?
WITNESSES
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
WHAT COULD HAVE BEEN DONE DIFFERENTLY TO PREVENT THIS INCIDENT FROM OCCURRING?
P&S DRIVER'S SIGNATURE

Clear
Should be Empty:

VEHICLE ACCIDENT REPORT

YOU ARE OUR BEST DEFENSE!

STOP WITNESSES AND GET THEIR CONTACT INFO BEFORE THEY LEAVE... ESPECIALLY IF YOU ARE AT FAULT!

POSITION YOUR TRUCK SO THE DASH CAMERA CAPTURES ALL OF THE POST-INCIDENT INTERACTIONS.

GET PICTURES AND VIDEOS

LOCATION OF ACCIDENT

ACCIDENT INFORMATION

OTHER PERSONS PERSONAL AND VEHICLE INFORMATION

POLICE INVESTIGATION

WITNESSES