Dispatch Accident Investigation Form
Case Number
Vendor
Date of Accident
Vendor Information
Monitor Name
Witness Name (s)
Accident Information
Type of Accident
Please select...
Major Accident with no injuries
Major Accident with injuries
Minor Accident with no injuries
Minor Accident with injuries
Officer's Name
Police Case/Incident #
Precinct
Did the accident result in property/vehicle damage
Yes
No
Did the accident result in a fatality
Yes
No
Was DOT Drug Test Required?
Yes
No
If driver is required to complete drug/alcohol test, they cannot operate any vehicle in service to CPS or associated institutions until the Director of Transportation formally permits it in writing.
Events During
Events Prior
Actions Taken to ensure immediate health
ODE T10 Report Submitted
Media Information
Was there a Media Inquiry
Yes
No
Name of Media Affiliate
Contact Information
Submitter's Email Address
Attach file/document
Status
Closed
Contact Information