This report form should be completed at the earliest opportunity after a manager receives notification that one of their direct reports was in involved in a safety incident. If you are unable to complete the form within 12 hours of an incident you should inform your direct supervisor.

This form will automatically be sent to FLEET, HR and SAFETY.  The purpose of early notification to these parties is to ensure that the injured party receives the appropriate treatment and investigations can be completed as soon as possible. Failure to complete this form in a timely manner will result in disciplinary action.

Additional Statement Forms

Please download the necessary statement forms using the links below.

Statement of Involved Party

Driver’s Accident Report

Witness Statement

Third–Party Statement

Refusal of Medical Attention Affidavit

Basic Information

Injury Specifics

Medical Treatment

Vehicle Incident Specifics (If Applicable)

Vehicle One

Vehicle Two

Police Report

Incident Photos or Forms