Company Vehicle Incident Report
I. General Information
Company Name: [Your Company Name]
Department: [Your Department]
Report Prepared By: [Your Name], Fleet Manager
Incident Report Number: CVIR-2024-05-001
Date of Report: May 20,2054
II. Incident Details
Date of Incident: May 18, 2054
Time of Incident: 2:30 PM
Location of Incident: Intersection of Main St. and 5th Ave, Springfield
III. Vehicle Information
Vehicle Make and Model: Ford Transit 2022
Vehicle License Plate Number: ABC-1234
Driver's Name: Jane Smith
Driver's License Number: D12345678
Driver's Contact Information: (555) 123-4567
IV. Incident Description
On May 18, 2054, at approximately 2:30 PM, the company vehicle driven by Jane Smith was involved in a collision at the intersection of Main St. and 5th Ave in Springfield. According to the driver, she was traveling north on Main St. when another vehicle, a Honda Civic, ran a red light from 5th Ave and struck the company vehicle on the passenger side. The impact caused significant damage to the side panel and the rear bumper of the Ford Transit. Weather conditions were clear and the road was dry at the time of the incident.
V. Witness Information
Witness Name: Mark Johnson
Witness Statement:
Mark Johnson, who was walking on the sidewalk near the intersection, stated that he saw the Honda Civic run the red light before colliding with the company vehicle. He confirmed that the Ford Transit had the right of way.
VI. Damage Assessment
Damage to Company Vehicle:
Description of Damage: Significant damage to the passenger side panel and rear bumper.
Estimated Repair Cost: $3,000
Damage to Other Vehicle(s) or Property:
VII. Police Report
Police Report Filed: Yes
Police Report Number: 2024-05-18-SPD
Officer’s Name and Badge Number: Officer Emily Brown, Badge #5678
VIII. Immediate Actions Taken
Immediate Actions:
Contacted emergency services and reported the incident.
Notified supervisor and fleet management department.
Arranged for the vehicle to be towed to the nearest repair shop.
Collected witness statements and took photographs of the damage and the scene.
IX. Follow-Up Actions
Follow-Up Actions:
Contact insurance company to file a claim.
Schedule a detailed vehicle inspection and obtain repair estimates.
Review the driver's account and check for any potential driver safety training needs.
Conduct a meeting with the fleet management team to discuss the incident and preventive measures.
X. Preventive Measures
Implement a refresher course on defensive driving techniques for all drivers.
Install dash cameras in all company vehicles to provide clear evidence in case of future incidents.
Review and reinforce the importance of adherence to traffic signals and awareness of surroundings.
XI. Signatures
Name: [Driver's Name]
Date: [Date Signed]
Name: [Supervisor's Name]
Date: [Date Signed]
Notes:
Ensure all sections are filled out accurately.
Attach any additional documents such as photos, police reports, or witness statements.
Keep a copy of this report for your records and submit the original to the designated department or individual.
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