Page 28 - Company Supplied Vehicles, Drivers' Manual v3
P. 28
Incident Checklist
Statement of Facts – Please complete at the scene if possible.
Date: Time: Weather:
Third party Name: Third Party Passenger Names
details Address:
Telephone No:
Car Registration No:
Car Make & Model:
3 Party Insurance Details:
rd
Witnesses Name: Name:
Address: Address:
Tel.No: Tel. No:
Injured Name: Name:
parties
Address: Address:
Tel. No. Tel. No.
Police Officer Name: Tel No:
notified
Y/N Officer No. Crime Ref. No:
Exact location of crash
Road type & road markings (if applicable)
Explain what happened in the crash
Describe the extent of the visible damage on your company car
Describe the extent of the visible damage on the third party car/s
Other damage or comments about the crash (if applicable)
Details of Name: Your passenger details
other third Address: Name:
party(s) Address:
Telephone No: Tel. No.
Car Registration No:
Car Make & Model:
3 Party Insurance Details:
rd
Commercial Drive4Life Handbook – January 2022 (Glen Dimplex Fleet Assistance – 01604 747269) Page 27 of 37
