Vehicle Incident/Accident Report

Vehicle Incident/Accident Report

All vehicle accidents must be reported to Risk Management.

All accidents that occur on public roads or highways must be reported to the appropriate Law Enforcement agency based on jurisdiction.

Incidents on Campus must also be reported to the Department of Public Safety at (208)-426-6911.

For Life-Threatening incidents, call 911.

Do not leave the scene of an accident before Law Enforcement officers have cleared you to leave.

Do not move your vehicle until police arrive and you are instructed to do so by Law Enforcement

Take photos of vehicle damage (including license plates) of all vehicles involved, the accident scene and surrounding area.

Exchange contact and insurance information for the involved vehicles. Ask for the responding officers information and report number, if applicable.

Do not make statements regarding fault, negligence or liability. Restrict comments to details regarding your actions in relation to the accident.

Notify your supervisor and complete the Vehicle Incident/ Accident Report as soon as possible but no later than 24 hours of the accident.

If a fatality, serious injuries, or extensive property damage, contact Risk Management as soon as practicable at (208)-426-3636 or via email to rmi@boisestate.edu.

For additional information or assistance, contact Risk Management at (208)-426-3636 or via email to rmi@boisestate.edu

State Agency: Boise State

First Name (Boise State Driver):*

Last Name (Boise State Driver):*

Driver Classification:*

Select

Employee Classification:*

Select All that Apply.

Select

Department:*

Job Title:*

Phone Number (Boise State Driver):*

E-Mail Address (Boise State Driver):*

License # (Boise State Driver):*

Was Supervisor Notified?*

Select or enter value

Supervisors Name:*

Supervisor's Email:*

Boise State Vehicle Damage

License Plate Number:*

State Vehicle-Year*

State Vehicle ID (VIN Number):*

State Vehicle-Make*

Select

State Vehicle-Model*

State Vehicle Damage Area:*

Select

State Vehicle Damage Type:*

Select

Other, Damage Description:*

State Vehicle Drivable:*

Select

State Vehicle Towed:*

Select

Estimated Cost or Repair/Replacement:*

Where Can Vehicle Be Seen?*

Description of Auto Incident/Accident

Date of Loss/Discovery:*

Time of Loss/Discovery:*

Location- State:*

Select

Location- City*

Location of Incident/Accident:*

Address or nearest cross street or intersection, highway, interstate, mile post marker, exit.

Description of Accident/Incident:*

Clearly describe how the accident or incident occurred or was discovered.

Speed of Boise State Vehicle at time of Accident:

Speed of Other Vehicle, if applicable:

Driver Signals:*

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Signal Type:*

Select

Indicate Traffic Controls:*

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Traffic Controls,Other Description:*

Weather Conditions:*

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Other Weather Conditions:*

Visibility Conditions:*

Select

Road Type:*

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Road Surface Type:*

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Road Conditions:*

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Road Conditions, other:*

Traffic Conditions:*

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Traffic Conditions, Other:*

Third Party Driver

Was Another Vehicle Involved:*

Select

Third-party First Name (Legal):*

Third-party Last Name (Legal):*

Third-party Phone:*

Third-party Address:*

Third-party Drivers License #:*

Third-party Vehicle License Plate #:*

Third-party Vehicle Year:*

Third-party Vehicle Make:*

Select or enter value

Third-party Vehicle Model:*

Third-party Damaged Area:*

Select

Third-party Damage Type*

Select

Third-party Insurance Company:*

Other Property Damaged

Other Property Damaged:*

Select

Type of Property:*

Select

Description of Property, Other:*

Owner's Name:*

Address:*

Description of Damage:*

Bodily Injury

Injury Accident:*

Select or enter value

Number of Injured Parties:*

Select

Injured Party Designation:*

If multiple vehicles and/or parties injured, please attach a separate document with the required information for each injured party, as known.

Select

Injured Party- First Name:*

Injured Party- Last Name:*

Phone Number(s) of Injured:*

Address of Injured (List all if applicable):*

Age(s) of Injured:*

Nature of Injury:*

Law Enforcement

Law Enforcement Response:*

Select

Law Enforcement Report Generated:*

Select

Department Report (DR) #:*

Name of Officer*

Law Enforcement Jurisdiction:*

Select all that apply

Select

Law Enforcement Jurisdiction, Other:*

Select

Named Law Enforcement Jurisdiction:*

Were Citations Issued (If yes, to whom)?

Select

Witness(es)

Witness(es)*

Select

First and Last Name(s) of Witness(es):

Witness(es) Phone Number(s):

File Attachments

File attachments can be word, pdf or jpeg. Videos should be emailed to rmi@boisestate.edu.

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