UO Vehicle Incident Report (formerly SVIR)

Please complete this form to report a vehicle incident or accident involving a UO driver on UO business. The driver and supervisor should complete the form together (both signatures are required below).

The documents in the vehicle incident packet will help you complete this form. This online form takes the place of the SVIR and "At the Scene" forms. Other forms or documents should be sent to Risk Management, lisat@uoregon.edu.

Risk Management will be notified when a form is submitted.

After completing this form, check the box at the bottom to receive a copy by email. REMINDER: If you received a citation for a traffic violation this must be reported to Parking and Transportation.

Please complete this section with only the driver's information.

Use dashes: 950-00-0000

Do you have your Driver Certification card from Parking and Transportation and is it current?

(e.g. OR, WA, ID)

(e.g. Food Service Worker 1, Swim team member, etc.)

Complete this section with information ONLY about the vehicle you were operating (other vehicle information can be entered below).

(e.g. "2013 Ford F250 Superduty")

If applicable (e.g. 09-01)

Please be specific. This information will be reviewed by Risk Management and the Accident Review Board. It is important to be complete and accurate, and include any information that you feel is relevant.

What factors contributed to the incident? (e.g. weather conditions, poor visibility, in a hurry, unfamiliarity with the vehicle, additional training needed, etc.)

Include full names and contact info

If there were no injuries to you, passengers, or others, select "No" and skip to the next section: Vehicle Damage.

Any employee injury must be reported to Risk Management. Complete the Safety Incident or Accident Report (SIAR) to report an injury: http://orm.uoregon.edu/content/injury-reporting-and-workers-compensation-forms

Information about the vehicle you were operating

Information about other drivers or vehicles involved in the incident (not you)

If no other vehicles were involved in the incident, select "No other vehicles" below and skip to next section: Property Damage.

If other driver was not UO-affiliated, skip ahead.

If other driver/vehicle was not UO-affiliated, skip to the next question.

If the other driver is not UO-affiliated, write their address below.

Important for filing a claim with a 3rd party

Important for filing a claim with a 3rd party

(e.g. "broken rear passenger-side taillight")

(e.g. "I dented a pole owned by the City of Eugene")

If any UO vehicle was damaged, complete this section.

Include name and contact information

Please note: each vehicle claim is subject to a $5,000 deductible.

Please attach any documents you have at this time, including photos, estimates for repairs, final invoices, or work tickets. If you obtain additional documents later, you can email them to lisat@uoregon.edu.

Anything else we need to know?

UO Driver: Please type your name below to certify that you have reviewed this information and it is correct to the best of your knowledge.

Supervisor/manager: Please type your name below to certify that you have reviewed this information and it is correct to the best of your knowledge.

CHECK THE BOX BELOW to receive a copy of this report.

Thank you and have a safe day!

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