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, firstname.lastname@example.org.
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.
UO Driver Information
Please complete this section with only the driver's information.
Architecture & Allied Arts, School
BAO Business Affairs Office
Budget and Finance Division
Budget and Resource Planning
Campus Planning & Real Estate
CAS College of Arts & Sciences
College of Business
Counseling & Testing Center
Education, College of
EMU Student Union
Enterprise Risk Services
IS Information Services
Journalism & Communicatn, School of
Law, School of
Music and Dance, School of
Parking and Transportation
PE & Recreation
President Administrative Operations
Printing & Mailing Services
Purchasing & Contracting Services
Senior VP and Provost Operations
UHC University Health Center
UOPD Police Department
Vice Provost for Budget & Planning
VP Finance & Admininstration Operations
VP for Equity & Inclusion
VP Student Affairs Administration
Your specific department
UO Driver's FIRST Name
UO Driver's LAST Name
Driver UO ID#
Use dashes: 950-00-0000
UO Driver Certified?
Do you have your Driver Certification card from Parking and Transportation and is it current?
Driver License #
Driver License State of issue
(e.g. OR, WA, ID)
Driver's UO affiliation
Temporary employee (UO)
Temporary employee (Agency)
Driver's UO position title
(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).
Vehicle Year, Make and Model
(e.g. "2013 Ford F250 Superduty")
Vehicle is owned by:
Rental Company (via UO contract)
Rental Company (other)
UO Vehicle ID #
If applicable (e.g. 09-01)
Vehicle Plate #
Date of Incident
Time of Incident (if known)
Purpose of Trip
Location of Incident
On Campus (street)
On Campus (parking lot)
Off campus (street)
Off campus (alley)
Off campus (parking lot)
Other (describe below)
Location of incident - Address
Description of incident
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.
Going Straight Ahead
Making a Left Turn
Making a Right Turn
Making a Turn
Making a U-Turn
Slowing or Stopping
Stopped in Traffic
Manner of Collision
Driver backed into vehicle or object
Driver hit vehicle or object head on
Driver hit vehicle or object - side impact
Driver hit by another vehicle
Other (theft, vandalism, hit by object, unclear)
Type of Collision
Hit Other Vehicle
Struck By Other
What factors contributed to the incident? (e.g. weather conditions, poor visibility, in a hurry, unfamiliarity with the vehicle, additional training needed, etc.)
Witnesses or Passengers
Include full names and contact info
Bodily Injury Information
Was anyone injured?
If there were no injuries to you, passengers, or others, select "No" and skip to the next section: Vehicle Damage.
If yes: Name(s) of injured people
Bodily Injury Nature
Any employee injury must be reported to Risk Management. Complete the Safety Incident or Accident Report (SIAR) to report an injury:
Information about the vehicle you were operating
Was the vehicle you were driving damaged?
If yes: Describe the damage to your vehicle
Other Vehicles or Drivers
Information about other drivers or vehicles involved in the incident (not you)
Other vehicle involved?
If no other vehicles were involved in the incident, select "No other vehicles" below and skip to next section: Property Damage.
Yes (Other UO vehicle)
Yes (Non-UO vehicle)
No other vehicles
Name of Other Driver
Was the incident caused by the other driver named above?
If UO: Department Name of Other UO Driver/Vehicle
If other driver was not UO-affiliated, skip ahead.
If UO: UO Vehicle # of other vehicle involved
If other driver/vehicle was not UO-affiliated, skip to the next question.
If 3rd Party: Address of Other Driver
If the other driver is not UO-affiliated, write their address below.
If 3rd Party: Phone number of Other Driver
Insurance Company of Other Driver
Important for filing a claim with a 3rd party
Insurance Policy Number
Important for filing a claim with a 3rd party
Description of Other Driver's Vehicle Damage
(e.g. "broken rear passenger-side taillight")
If another vehicle was damaged but the owner was not present, did you leave the green information card at the scene?
Aside from any vehicles involved, was any property damaged?
If yes: Describe the property damage and property owner
(e.g. "I dented a pole owned by the City of Eugene")
Repairs and Estimates
If any UO vehicle was damaged, complete this section.
Have you obtained estimates for the damage?
Yes (attach below)
Will the vehicle be repaired?
Yes, and repairs are complete (attach final cost document below)
Yes, in process now
Who can we contact regarding vehicle repairs?
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 email@example.com.
Anything else we need to know?
UO Driver Signature
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.
UO Driver email
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!
Send me a copy of my responses
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