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Accident Checklist

Be prepared. Print out copies of this Accident Checklist to keep in the glove box of every vehicle your family owns.

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Safety First: Call 911

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Date:  _______________________________

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Time:  _______________________________

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Where did accident occur (street names)?
______________________________________________________
______________________________________________________

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Were there any injuries?

Pedestrians? _________________________________________
Passengers? _________________________________________
Name _______________________________________________
Address _____________________________________________
Phone ______________________________________________

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Get important information at the scene.
In addition to getting information from other drivers, be sure to get at least the names and phone number of any witnesses or people who stopped to help.

Driver 1

Name:

_____________________________

Address:

_____________________________
_____________________________

Phone:

_____________________________

Driver's License No.: ______________________   Exp. Date: ___________

Date of birth: _____________________

Their Insurance Co.: ___________________________________________

Their Insurance Policy No.: ______________________________________

Registered Owner of the Vehicle: ________________________________

License No. of their vehicle: ______________________________________

State: __________  Year: __________  

Make/Model: __________  Color: __________

No. of Passengers: _____________________________


Driver 2

Name:

_____________________________

Address:

_____________________________
_____________________________

Phone:

_____________________________

Driver's License No.: ______________________   Exp. Date: ___________

Date of birth: _____________________

Their Insurance Co.: ___________________________________________

Their Insurance Policy No.: ______________________________________

Registered Owner of the Vehicle: ________________________________

License No. of their vehicle: ______________________________________

State: __________  Year: __________  

Make/Model: __________  Color: __________

No. of Passengers: _____________________________


Driver 3

Name:

_____________________________

Address:

_____________________________
_____________________________

Phone:

_____________________________

Driver's License No.: ______________________   Exp. Date: ___________

Date of birth: _____________________

Their Insurance Co.: ___________________________________________

Their Insurance Policy No.: ______________________________________

Registered Owner of the Vehicle: ________________________________

License No. of their vehicle: ______________________________________

State: __________  Year: __________  

Make/Model: __________  Color: __________

No. of Passengers: _____________________________


Witness 1

Name:

_____________________________

Address:

_____________________________
_____________________________

Phone:

_____________________________

Witness 2

Name:

_____________________________

Address:

_____________________________
_____________________________

Phone:

_____________________________

Witness 3

Name:

_____________________________

Address:

_____________________________
_____________________________

Phone:

_____________________________

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Share only pertinent information at the scene.
Provide only your driver's license and registration to the other driver, injured persons, or police officers. Do NOT discuss the circumstances of the accident with anyone except the police. Do NOT discuss responsibility with anyone except a positively identified representative of your insurance company.

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Arrange for towing your vehicle.
Don't sign any towing release that authorizes repair of your vehicle unless you have decided to have your car repaired by the facility where the towing company will take your car.

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Complete an Accident Record.
Write down everything you can remember about the accident. Include as many details as possible. Revisit the scene at a later time if necessary to take pictures.

Draw a diagram of the accident marking the vehicles involved (A, B, C, etc.) and showing the direction the vehicles were traveling and where accident occurred. Mark street names, stop signs, traffic lights, and other landmarks. Describe other pertinent information:

Street Diagram

_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________

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Report the accident to the Department of Motor Vehicles.
Washington State Law requires that all accidents involving injury/death or property damage in excess of $500.00 be reported within ten (10) days to the Department of Motor Vehicles.

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Notify your Insurance Agent immediately.
Date: __________________  Time: ___________ a.m./p.m.

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Evaluate repair estimates carefully.
Washington State Law protects you. You have the right to take your vehicle to the repair facility of your choice and are not obligated to use the repair shop mandated by your insurance company. Make sure all necessary repairs are fully itemized. Ask questions: Was the alignment checked? Why is the hood being repaired, not replaced? and so on.

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Choose a quality collision repair facility.
Visit our web site at www.cityautobody.com for more helpful tips on how to evaluate and select a collision repair facility.

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Make sure all work is done to your satisfaction before signing any insurance company release for payment.

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CITY EAST

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2512 North Woodruff Rd.
(East of Argonne Village)
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