Crash Report

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What to do When Involved in a Crash

The basic steps that the driver should perform at the crash scene are as follows:
• Stop immediately and secure the vehicle (shut off the engine and set the brakes).
• Protect the area by properly placing emergency warning devices.
• Assist any injured person (the driver should never move an injured person unless they are in imminent danger).
• Notify the policy and emergency services. Be specific about location, how many are injured and the extent of the injuries and if HazMat is involved.
• Report the crash to your manager.
• Maintain a professional demeanor, regardless of who was at fault.
• Provide his/her name, the company’s name, insurance policy information, and driver's license to the other party(ies) involved. The driver should not discuss details of the crash with anyone except his/her employer, police or the company's insurance provider.
• Complete the form below.

Emergency Contacts

Chemtrec

1-800-424-9300

Dave Carey

1-847-214-2100 ext. 9232

Darlene Lichthardt

1-847-214-2100 ext. 9221

Commercial Vehicle Crash Form

"*" indicates required fields

Step 1 of 5

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Tap the 'Edit' icon below, then use your finger to illustrate.

Incident

Date of Accident*
AM/PM*
Please enter a number greater than or equal to 1.

Location

Cause of Crash

Other Involved Driver and Vehicle

Name
Address*
*If additional vehicles are involved, fill out "Additional Driver/Vehicle Form"

Police/Medical Services

Company Employee
Transported by Ambulance*

Occupants of Other Vehicle
Transported by Ambulance*

Pedestrians
Transported by Ambulance*

Witnesses

Have you identified witnesses?*
*If yes, complete witness form
Did crash damage cause ANY vehicle to be towed?*

Additional Driver and Vehicle

Were additional vehicles involved?*

Additional Driver and Vehicle #1

Name
Address*

If additional vehicles were involved:

Additional Driver and Vehicle #2

Name
Address

Additional Driver and Vehicle #3

Address

Additional Driver and Vehicle #4

Name
Address
Date*

Witness #1

Date

Witness #2

Date

Hazardous Materials Incident

Hazardous Materials Incident




Was there a leak, spill, or release as a result of the crash?*
Is fuel leaking from the company vehicle involved?*
Was the fire department and/or emergency HazMat Response Called?*