Vehicle Incident Report Form

Employee's Name Submitting Report:*
Department*
Date of Vehicle Incident:*
MM slash DD slash YYYY
Time of Incident

: Hours

Minutes

AM/PM
District Vehicle Involved:*
District Employees Involved:*
What task were you performing when the incident occurred?*
Description of Incident*
Describe the incident in as much detail as possible. Also describe the specifics of any damage that occurred. (Note: There will be an opportunity to attach photos and a sketch later in this form. )
Were you injured?*
- Yes
- No
Was anyone else injured?*
- Yes
- No
If there were any injuries, please fill out the appropriate Injury Form.
Additional comments:
If you have any additional comments to add to this report or suggestions to prevent this from happening in the future, please add that information here.
Witness(es) to the incident:
Photos (optional)
If you have photos to help support this report, please upload them here.
Drop files here or

Max. file size: 64 MB.
Sketch (optional)
If appropriate, draw a sketch of intersection or area where incident occurred and attach here. Draw arrow indicating north.
Drop files here or

Max. file size: 64 MB.
Email*

2710 Curtiss Street
Downers Grove, Illinois 60515-0703

Phone: (630) 969-0664
Fax: (630) 969-0827

Monday-Friday: 8 a.m. - 4:30 p.m.

Saturday and Sunday: Closed

Contact