City, State, Zip
Vehicle Registration/year/license number
Make/model of car and year
Does driver appear to have been drinking or using drugs
Any statements made by other driver:
Position of your car after accident
Position of other car after accident
Location of any tire marks, auto debris, glass, dirt, etc. on road or side of road
Place of impact on other car
Name/address of wrecker that towed other car
Other conditions that affected accident
Did your car skid? If so, how many feet?
Did other car skid? If so, how many feet?
Traffic Controls (traffic lights, stop signs, etc.)
Date of accident
Time of accident
Location of accident
Type of road (grade, curve, etc.)
Speed of your car before accident
Speed of other car before accident
Direction of your car
Direction of other car
Were your turning?
Was other driver turning?
Did the other driver signal properly (with arm, horn, lights, etc.)?
If at night, were other vehicle's lights on?
How far away from you was the other car when you first saw it?
Other relevant facts