MO Project: Contextual Branding

Office of Administration

General Services

Excellent customer service, every time.

Accidents in State Vehicles

Print

In Case of Accident Brochure

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.

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Location of Accident

____________________________________________
City

____________________________________________
Name of Officer Badge #

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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 #MO300-0068.

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.