University of South Alabama
Accident Report Form
Whenever a University vehicle sustains damage of any kind, or is involved in an accident which results
in property damage, this accident report form must be completed as soon as possible by the driver and
presented in person to the Safety and Environmental Compliance Department in the Central Services
Administration Building, Room 328. Contact University Police to investigate all accidents.
Please note that this form is for University Vehicles Use Only and is not meant to supercede the
official USA accident/incident form. Submit report on the date of the actual occurrence, not the next
business day.
University Vehicle
__________________________________________________________________________________
Driver’s Name
Title
__________________________________________________________________________________
Department
University J Number
Work Phone
__________________________________________________________________________________
Type of Vehicle
Make
Model
__________________________________________________________________________________
License No.
Vin No.
Describe Damage _________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Property Damage Other Than Vehicle (fence, utility pole, etc.)
__________________________________________________________________________________
Damaged Property Owner’s Name
Street Address
__________________________________________________________________________________
City
State
Zip
Location and Time of Accident
__________________________________________________________________________________
Date
Day of the week
Hour
Address
Circle One: Main Campus
SHAC
USA Brookley
Commons
USAMC
Passengers In Your Vehicle
Created August, 2011
USA Children and
Women’s
Name
Address
Name
Witnesses
Addresses
Description of Accident
___Head-on __Sideswipe __Right Angle __Overturn ___Rear End: ___You Hit____ You were hit
____Other, please describe ____________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Weather Conditions
Road Conditions
Flags and Warning Signs in Use: Yes No
What Happened? Describe in Detail - Refer to vehicles according to number ___________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Any injuries: Yes
No
If so, a University Injury/Incident form must be completed in addition to this form.
Created August, 2011