Sweetwater School District #1

Traffic Accident Report

Sweetwater School District #1
DATE OF INCIDENT*

MonthDayYearHourMinutesAM/PM Option
Was there a Law Enforcement Investigation*
Type of Law Enforcement

Wyoming Highway PatrolSheriffCity Police Department
Officer Name

First NameLast Name
Officer Badge Number
Case Number

VEHICLE #1 INFORMATION

Sweetwater County School District #1, 3550 Foothill Blvd., Rock Springs, WY, 82901
VEHICLE #*
LICENSE PLATE #*
VEH. IDENTIFICATION #*
VEH. MAKE/MODEL*
DRIVERS LIC #*
LIC STATE*
Driver/Passenger Information for Vehicle #1
DRIVER'S NAME*

First NameLast Name
Email*
example@example.com
GENDER*
Birth Date*

MonthDayYear
Driver's Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
DESCRIBE DAMAGE*

Bus Seat Number Chart

Left Side	Right Side
Driver	Aide
Seat 1	Seat 2
Seat 3	Seat 4
Seat 5	Seat 6
Seat 7	Seat 8
Seat 9	Seat 10
Seat 11	Seat 12
Seat 13	Seat 14
Seat 15	Seat 16
Seat 17	Seat 18
Seat 19	Seat 20

Number of Passengers

Passenger Information

	Seat Number	Seating Position	Last Name	First Name	Phone Number	Injury Status	Safety Equipment Used
Driver
Passenger 1
Passenger 2
Passenger 3
Passenger 4
Passenger 5
Passenger 6
Passenger 7
Passenger 8
Passenger 9
Passenger 10
Passenger 11
Passenger 12
Passenger 13
Passenger 14
Passenger 15
Passenger 16
Passenger 17
Passenger 18
Passenger 19
Passenger 20

VEHICLE #2 INFORMATION

(DRIVER OF VEHICLE #2)
LIC. PLATE NUMBER
YEAR
MAKE/MODEL
VIN
LIC STATE
Driver/Passenger Information for Vehicle #2
DRIVERS NAME

First NameLast Name
Birth Date

MonthDayYear
Phone Number

Area CodePhone Number
DRIVERS LIC #
GENDER
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Insurance Company
Policy Number
Describe Damage
Number of Passengers

Passenger Information

	Seat Number	Seating Position	Last Name	First Name	Phone Number	Injury Status	Safety Equipment Used
Driver
Passenger 1
Passenger 2
Passenger 3
Passenger 4
Passenger 5
Passenger 6
Passenger 7
Passenger 8
Passenger 9
Passenger 10
Passenger 11
Passenger 12
Passenger 13
Passenger 14
Passenger 15
Passenger 16
Passenger 17
Passenger 18
Passenger 19
Passenger 20

Accident Details
TYPE OF ACCIDENT*
WEATHER*

CLEARCLOUDY-OVERCASTRAINSNOWSEVERE WINDHAIL/SLEETFOG/SMOKE
ROADWAY CHARACTER*
LIGHT CONDITIONS*
TRAFFIC CONTROL*
ROAD SURFACE*
TRAFFIC CONDITIONS*
PRE-ACCIDENT VEHICLE ACTION (VEH. 1)*
PRE-ACCIDENT VEHICLE ACTION (VEH. 2)
LOCATION
ADDRESS RESPONDING TO*

STREET ADDRESS

INTERSECTING WITH

CITY/TOWN/VILLAGECOUNTY

RUN NUMBERCountry
DIAGRAM - Draw street/intersection and position of each vehicle involved
DESCRIBE WHAT HAPPENED*
UPLOAD ANY RELEVANT FILES

Browse Files

Cancelof
Witnesses:
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
ALT. Phone Number

Area CodePhone Number
Full Name

First NameLast Name
Phone Number

Area CodePhone Number
ALT. Phone Number

Area CodePhone Number

TODAYS DATE*

MonthDayYearHourMinutesAM/PM Option
DRIVER NAME*

First NameLast Name
DRIVER SIGNATURE*
Should be Empty: