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2. Instructions:

   All vehicle accidents that result in an injury to any person(s) OR damage to any property shall be reported using the below form immediately following the accident or as soon as practicable.

4. Your Name:*
6. Department:*
   -- Select One --City AdministrationCity AttorneyHuman ResourcesFinancial ServicesInformation TechnologiesPublic WorksUtilitiesParks, Recreation & Community ServicesCity ClerkDevelopment ServicesPolice DepartmentFire & Rescue DepartmentLibrary & Information ServicesMunicipal Court
8. Phone Number:*
10. Date & Time of Accident:*
    Date & Time of Accident:

    Date & Time of Accident:
12. Location of Accident:*
16. Did the accident result in injury to any person(s)?*

    1. Yes
    2. No
18. If yes, is the injured person(s) employed by the City?*

    1. Yes
    2. No
20. Did the accident result in any damage to any property?*

    1. Yes
    2. No
22. If yes, is the damaged property owned by the City? *

    1. Yes
    2. No
24. Vehicle Unit #*
26. Was a traffic citation issued to any party involved in the accident? *

    1. Yes
    2. No
28. Police Report #*

30. Submission of this form will prompt an immediate message to HR, Legal, and Public Works-Fleet. Upon receipt, all necessary parties will contact you directly with further direction.

Leave This Blank:


32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

* indicates a required field