If you are involved in an accident use this form to record as much information as you can.

Remember!
  • Do try to stay calm
  • Do not admit liability to anyone
  • Do take photos (damage/location/conditions)

 

Accident Form

Accident details

Please include any additional information about the location if needed.

Your Vehicle

Outline in as much detail as necessary the nature nature of the damage to your vehicle in in text box below:
If yes please list the names separted by a comma (e.g. John Smith, Paul Green, etc) in the text box below

Other Vehicle

How many vehiicles other than your own were invloved in this accident?
Vehicle 1
Outline in as much detail as necessary the nature nature of the damage to the other vehicle(s) in in text box below:
If yes please list the names separted by a comma (e.g. John Smith, Paul Green, etc) in the text box below
List the names of the passenngers in other vehicle 1
If yes please list the names, contact details (address, telephone number, etc) and status (driver/passenger/pedestrian) separted by a comma (e.g. John Smith, driver, mobile 123, Paul Green pedestrian, 46 Acacia Avenue, etc) in the text box below:
Vehicle 2
Outline in as much detail as necessary the nature nature of the damage to the other vehicle(s) in in text box below:
If yes please list the names separted by a comma (e.g. John Smith, Paul Green, etc) in the text box below
List the names of the passenngers in other vehicle 1
If yes please list the names, contact details (address, telephone number, etc) and status (driver/passenger/pedestrian) separted by a comma (e.g. John Smith, driver, mobile 123, Paul Green pedestrian, 46 Acacia Avenue, etc) in the text box below:
Vehicle 3
Outline in as much detail as necessary the nature nature of the damage to the other vehicle(s) in in text box below:
If yes please list the names separted by a comma (e.g. John Smith, Paul Green, etc) in the text box below
List the names of the passenngers in other vehicle 1
If yes please list the names, contact details (address, telephone number, etc) and status (driver/passenger/pedestrian) separted by a comma (e.g. John Smith, driver, mobile 123, Paul Green pedestrian, 46 Acacia Avenue, etc) in the text box below:
If more than 3 vehicles were involved in the accident, please give details of the other vehicles below:

Witnesses

Select Yes or No below
Select yes or no below:
If there are more than 2 witnesses list their names addresss and contact numbers in the text box below:

Police information

Pleae outline any further information regarding th epolice presence/involvment at the scene of the accident.

Description of accident

Please descibe the accident and include any notes are information not included above which you feel would be helpful.

Please upload any photographs you have taken of the scene of te acident, any drawings you have done can be photoraphed on you phone or tablet and uploaded. There are 6 upload portals below. If you need more simply use your phone to take more photographs and e-mail them to admin@barrowelectrical,co.uk

You can open this field and it will let you take a photograph and add it to the form, or you can take a photograpph from your photo library.
You can open this field and it will let you take a photograph and add it to the form, or you can take a photograpph from your photo library.
You can open this field and it will let you take a photograph and add it to the form, or you can take a photograpph from your photo library.
You can open this field and it will let you take a photograph and add it to the form, or you can take a photograpph from your photo library.
You can open this field and it will let you take a photograph and add it to the form, or you can take a photograpph from your photo library.
You can open this field and it will let you take a photograph and add it to the form, or you can take a photograpph from your photo library.
Ths is an accurate description of the events leading to and associated with the accident as I understand them.