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Motor Vehicle Accident Report Template
Document the facts of a vehicle accident clearly for insurance, court, employer, or personal records.
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Motor Vehicle Accident Report Template
[Your Full Name]
[Street Address]
[City, State/Province, ZIP/Postal Code]
[Phone Number]
[Email Address]
Date of Birth: [MM/DD/YYYY]
1. Basic Accident Information
Accident Date: [MM/DD/YYYY]
Accident Time: [HH:MM a.m./p.m.]
Accident Location (Street Address / Intersection / Mile Marker): [Location Description]
City: [City]
State/Province: [State/Province]
County (if applicable): [County]
Type of Road: [Highway / City Street / Rural Road / Parking Lot / Other]
Road Direction(s): [e.g., “Northbound / Southbound”]
Weather Conditions at Time of Accident: [Clear / Rain / Snow / Fog / Other]
Lighting Conditions: [Daylight / Dawn / Dusk / Dark – Streetlights / Dark – No Streetlights]
Road Surface: [Dry / Wet / Icy / Snowy / Gravel / Other]
2. Your Vehicle and Driver Information
Driver Name: [Your Full Name]
Driver’s License Number and State/Province: [License No., State/Province]
Vehicle Owner (if different): [Owner Name]
Vehicle Year, Make, Model: [Year, Make, Model]
Vehicle Color: [Color]
License Plate Number and State/Province: [Plate, State/Province]
Insurance Company: [Insurance Company Name]
Policy Number: [Policy Number]
Insurance Company Phone: [Phone Number]
3. Other Vehicle and Driver Information
Vehicle 2
Driver Name: [Driver’s Full Name]
Driver’s License Number and State/Province: [License No., State/Province]
Vehicle Owner (if different): [Owner Name]
Vehicle Year, Make, Model: [Year, Make, Model]
Vehicle Color: [Color]
License Plate Number and State/Province: [Plate, State/Province]
Insurance Company: [Insurance Company Name]
Policy Number: [Policy Number]
Insurance Company Phone: [Phone Number]
[If more than two vehicles were involved, copy this section and label as “Vehicle 3,” “Vehicle 4,” etc.]
4. Occupants and Injuries
Occupants in Your Vehicle
Name: [Name] – Seat Position: [Driver / Front Passenger / Rear Left / Rear Center / Rear Right / Other]
Injury: [None / Minor / Serious] – Description: [Brief description or “N/A”]Name: [Name] – Seat Position: [Seat Position]
Injury: [None / Minor / Serious] – Description: [Brief description]
[Add additional lines as needed.]
Occupants in Other Vehicle(s)
Vehicle 2 Occupants:
Name: [Name] – Seat Position: [Seat Position]
Injury: [None / Minor / Serious] – Description: [Brief description]Name: [Name] – Seat Position: [Seat Position]
Injury: [None / Minor / Serious] – Description: [Brief description]
[Add additional lines and repeat for each vehicle, as needed.]
5. Property Damage
Damage to Your Vehicle:
Area(s) of Impact: [e.g., “Front left,” “Rear bumper,” “Passenger side”]
Visible Damage Description: [Crushed, dented, broken glass, deployed airbags, etc.]
Whether Vehicle Was Towed: [Yes / No] – Towed To: [Tow Company Name and Location]
Damage to Other Vehicle(s):
Vehicle 2 Area(s) of Impact: [Description]
Visible Damage Description: [Description]
Other Property Damage (fences, buildings, signs, guardrails, personal property):
Description of Property: [Type and owner, if known]
Damage Description: [Brief description]
6. Detailed Description of Accident
Provide a clear, factual description of how the accident occurred. Include directions of travel, lane positions, traffic signals or signs, speeds (if known), and actions taken by each driver.
Before the collision, my vehicle was traveling [direction, lane, speed if known] on [road name]. The other vehicle was traveling [direction, lane, speed if known] on [road name].
[Describe events step by step, for example:]
[Describe approach to intersection, traffic signals, stop signs, or yield signs.]
[Describe actions such as turning, changing lanes, stopping, slowing, or accelerating.]
[Describe point of impact and how the vehicles moved immediately after impact.]
[Mention any evasive actions taken (braking, swerving) and whether horns or signals were used.]
If the accident involved parked vehicles, pedestrians, cyclists, or fixed objects, describe their position and what occurred.
7. Accident Diagram (If Needed)
Use this section to create a simple diagram of the accident scene. Show:
Road names and directions (with arrows).
Lane markings, traffic signals, stop signs, or yield signs.
Position of each vehicle before, at the moment of impact, and after the collision (labeled “V1,” “V2,” etc.).
Any relevant landmarks (driveways, intersections, medians, buildings).
[Space for diagram or note: “Diagram attached as separate page.”]
8. Witness Information
Witness 1:
Full Name: [Name]
Phone Number: [Phone Number]
Email (if known): [Email Address]
Street Address (if known): [Address]
Brief Summary of What Witness Observed (if known):
[Short description]
Witness 2:
Full Name: [Name]
Phone Number: [Phone Number]
Email (if known): [Email Address]
Street Address (if known): [Address]
Brief Summary of What Witness Observed (if known):
[Short description]
[Add additional witness sections as needed.]
9. Police, Emergency, and Citation Information
Police Agency Responding: [Agency Name – e.g., City Police, State Police, Sheriff]
Officer Name(s): [Name(s) if known]
Badge Number(s): [Number(s) if known]
Police Report Number (if available): [Report Number]
Was a Police Report Filed? [Yes / No / Unknown]
Citations Issued:
To You: [Yes / No] – If Yes, Citation(s) for: [Offense(s)]
To Other Driver(s): [Yes / No / Unknown] – If Yes/Unknown, details (if known): [Description]
Emergency Medical Response (EMS/Fire): [Yes / No]
If Yes, Agency and Actions Taken (e.g., transport to hospital, on-site treatment): [Description]
10. Insurance and Claim Information
Your Insurance Claim Number (if assigned): [Claim Number]
Adjuster Name (if known): [Name]
Adjuster Phone/Email: [Contact Information]
Other Driver’s Claim Number (if known): [Claim Number]
Related Legal or Administrative Case Numbers (if applicable):
DUI or Traffic Case No.: [Number]
Civil Case No.: [Number]
DMV or Administrative Case No.: [Number]
11. Additional Notes or Attachments
Use this section to list and briefly describe any documents, photos, or other materials attached to this report:
Photographs of vehicle damage
Photographs of accident scene
Copy of police report or incident card
Medical documentation summary or discharge instructions
Repair estimates or invoices
Other: [Description]
Additional Notes:
[Free text area for any other important details not covered above.]
12. Certification
I, [Your Full Name], certify that the information provided in this Motor Vehicle Accident Report is true and accurate to the best of my knowledge and recollection. If I later become aware of significant new information, I will update or supplement this report as needed.
Signature: _______________________________
Printed Name: [Your Full Name]
Date: [MM/DD/YYYY]
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Learn more about
Motor Vehicle Accident Report Template
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
Click below for detailed info on the template.
For quick answers, scroll below to see the FAQ.
MOTOR VEHICLE ACCIDENT REPORT TEMPLATE FAQ
What is a motor vehicle accident report?
A motor vehicle accident report is a written record that captures the essential facts of a traffic accident, including who was involved, when and where it happened, how it occurred, and what injuries or property damage resulted. It may be used by insurance companies, attorneys, employers, or courts to understand what happened and evaluate claims or liability.
When should I complete a car accident report?
You should complete a car accident report as soon as reasonably possible after a crash, while events are still fresh in your memory. Many people prepare their own accident report in addition to any police or official report, especially for insurance claims, employer requirements, or legal matters such as a DUI-related collision.
What information should I include in a motor vehicle accident report?
A helpful motor vehicle accident report usually includes: date, time, and location of the crash; weather and road conditions; information about all drivers, passengers, and vehicles; a description of the sequence of events; diagrams or sketches; any injuries or property damage; witness information; and details about police response, citations, or reports. Clear, factual descriptions are more useful than opinions or blame.
Can I use this accident report template for an insurance claim or DUI-related case?
Yes. This accident report template can be adapted for insurance claims, civil cases, or criminal and DUI-related matters where a clear written description of the collision is needed. Always follow any instructions provided by your insurance company, employer, attorney, or court, and attach photos, official police reports, or other documents as requested.
How detailed should my car accident report be?
Your accident report should be detailed enough to reconstruct what happened, but focused on facts. Include specific times, distances, directions, speeds (if known), traffic control devices, and actions taken by each driver, but avoid speculation about things you did not personally see or know. If you are unsure about something, you may say so rather than guessing.
Can AI Lawyer help me draft or organize my accident report?
Yes. AI Lawyer can help you organize your accident information into a clear, readable accident report by suggesting wording, structure, and layout. You provide the real dates, locations, and facts, and AI Lawyer helps format them into a document you can review with your attorney, insurer, or employer. This template and any AI-generated content are for general information and document organization only and are not legal advice. For legal strategy or case-specific guidance, you should consult a licensed attorney.
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