Risk Management In Case of Accident
1. Aid the Injured
Do not move injured individuals unless absolutely necessary! Warn other drivers.
2. Call the Police
Give exact location and advise if medical help is needed. Write down the name and badge numbers of the police officers who assist you.
____________________________________________
Location of Accident
____________________________________________
City
____________________________________________
Name of Officer Badge #
____________________________________________
Name of Officer Badge #
____________________________________________
Was Summons Issued? To Whom?
3. Record Facts About State Vehicle
Complete all information concerning the state vehicle.
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Date of Accident Time AM/PM
___________________________________________
Department/Division/Section
___________________________________________
Driver's Name Social Security #
___________________________________________
Street Address Phone
___________________________________________
City State Zip
___________________________________________
Year of Vehicle/Make/Model License Plate #
___________________________________________
Nature of Damage
4. Obtain Facts About Other Vehicle
It is important to get the name, address of other driver(s) involved.
1) ________________________________________
Name Phone
________________________________________
Street Address
________________________________________
City State Zip
________________________________________
Year of Vehicle/Make/Model License Plate #
________________________________________
Insurance Company
________________________________________
Nature of Damage
2) ________________________________________
Name Phone
________________________________________
Street Address
________________________________________
City State Zip
________________________________________
Year of Vehicle/Make/Model License Plate #
________________________________________
Insurance Company
________________________________________
Nature of Damage
5. Obtain Facts About Injured Persons
It is important to obtain the name, age, address, and nature of injury of anyone injured.
1) ________________________________________
Name Age
________________________________________
Street Address Phone
________________________________________
City State Zip
Injured was: ___ In my vehicle ___ In other vehicle ___ Pedestrian
6. Record Facts About Other Property Damage (Non-Vehicular)
Complete all information concerning damage to other property (fences, mailboxes, etc.)
____________________________________________
Owner Phone
____________________________________________
Street Address
____________________________________________
City State Zip
____________________________________________
Object Damaged
____________________________________________
Nature of Damage
7. Get Witnesses
Get the name and address of all available witnesses to the accident.
1) __________________________________________
Name Phone
__________________________________________
Address
__________________________________________
City State Zip
8. Call Risk Management (573) 751-4044
Within 24 hours of the accident.
9. Don't Comment
Do not make any statement concerning the assumption of liability. Give out only that information required by authorities. Do not sign any statement except for an authorized representative of the Risk Management Section.
10. Automobile Loss Notice
Complete in full an Automobile Loss Notice Form #MO 300-0068.
Describe the Accident!
Mail or fax with a completed Automobile Loss Notice form #MO300-0068
Send a copy of the police report when available:
Office of Administration
Risk Management Section
P.O. Box 809
Jefferson City, MO 65102
Fax: (573) 751-7819
This page may be printed off and placed in the glove compartment of the car you are operating to help you in case of an accident.
