Page 41 - On Call folder
P. 41

Injured persons

         Are there any Injured parties?                                                Yes / No
         If Yes:
         Name:
         Address:


         Details of injuries:



         Did an ambulance attend the scene?                                            Yes / No
         If Yes, enter it’s details here


         Injured persons (continued)
         Are there any more Injured parties?                                           Yes / No
         If Yes:
         Name:
         Address:


         Details of injuries:



         Did an ambulance attend the scene?                                            Yes / No
         If Yes, enter it’s details here


         Passengers – Names and addresses of passengers in insured vehicle
         Name:
         Address:


         Name:
         Address:


         Name:
         Address:



         Witnesses – Names and addresses of all independent witnesses
         Name:
         Address:


         Name:
         Address:


         Name:
         Address:



         Police details – Name, number and station

         Police officer’s name:


         Police officer’s number:

         Police station’s address:









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