For Kim Woods Only
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unit_iii_accident_report_form.docParkville Fire and Rescue
Accident Report
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Date and Time of accident _____________________________________________________________ Location of accident ___________________________________________________________________ |
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Name of driver __________________________Supervisor____________________________________ For what purpose was the vehicle being used at the time of the accident ________________________________________________________________________________________________________________________________________________________________________ What is the damage to the city vehicle ____________________________________________________ ____________________________________________________________________________________
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Damage to Property of others |
Owner __________________________ Address______________________________ Driver___________________________ Address _____________________________ List damage ___________________________________________________________ If auto make and year ________________________ Tag#______________________ Insurance company _____________________________________________________
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Persons Injured |
NAME Address Injury
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Witnesses |
NAME Address Injury
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Note: Any additional comments should be made in a separate word document and uploaded with the assignment.
Signature of driver ______________________________Date___________
Signature of supervisor ___________________________ Date _________
Signature of investigating officer ____________________ Date _________
