Get Report Of Incident / Property Damage / Injury

Filling out the REPORT OF INCIDENT / PROPERTY DAMAGE / INJURY form is an important step in documenting incidents related to property damage or personal injury. This guide will provide clear instructions on how to effectively complete the form online, ensuring that you provide all necessary details.

Follow the steps to successfully fill out the form:

1. Click ‘Get Form’ button to access the document and open it in the designated editor. Ensure you have an internet connection to complete this process.
2. Begin by entering your full name in the designated fields, including your first name, middle initial, and last name. Select your gender by circling the appropriate option.
3. Fill in your address, city, state, and zip code accurately to ensure proper identification.
4. Indicate today’s date and the date of the incident. Make sure to specify the day of the week as well.
5. Select whether or not you took photos at the time of the incident. If applicable, note that you can attach photos later in the submission.
6. Provide your phone number and date of birth, ensuring all information is current.
7. Specify the location of the incident and enter your driver’s license number along with the current weather conditions.
8. If applicable, include your social security number and email address for communication purposes.
9. In the section provided, briefly describe how the accident or injury occurred.
10. Respond to whether you were injured in the incident and, if so, provide details of the injuries.
11. If applicable, indicate whether you were transported by ambulance and provide the name and address of the facility involved.
12. List any witnesses to the incident, along with their contact information in the provided fields.
13. For the loss of wages or income, indicate if you experienced any loss due to the incident by selecting yes or no, and provide dates if applicable.
14. Complete the employer information section by providing details for all relevant employers affected by the incident, including company names and contact information.
15. In the property damage section, indicate whether a city vehicle was involved. Also, specify if your vehicle is drivable and provide relevant vehicle details.
16. Provide any additional information that may be relevant to the investigation of your claim in the designated area.
17. At the end of the form, sign and date the document to affirm that the information provided is accurate. Ensure that a notary public witnesses your signing.
18. Once all fields are filled out, save your changes, and you may choose to download, print, or share the completed form.

Complete your REPORT OF INCIDENT / PROPERTY DAMAGE / INJURY online today.