Driver's Statement Checklist

Date and location of the statement, identification of the parties to the interview, and the manner the interview is being conducted.

If by telephone request permission to record.

About the driver:

• Full name, age, address, driver' license number, social security number or other national identification.

• Identity of driver's employer, including address and telephone.

• Name and address of next of kin.

• Prior violations and accidents.

  About the insured vehicle and how it was being used:

• Year, make, model, vehicle identification number and license number?

• Who owns the vehicle?

• Purpose of the trip?

• Activities in the hours before the accident?

• About the accident scene:

• Date, time and location of the accident.

• Give a general description of street type, width, lane markings, traffic controls and so forth.

• What were the road surface conditions and type of pavement?

• What traffic signals and signs?  If signals, were they operating?

•  Was there any road construction or unusual activities?

• Weather conditions, obstructions to view, lighting conditions?

About the passengers:

• Identification and relationship to you?

• Position in vehicle and seatbelt use?

About the accident:

• The speed, distance, and location of each vehicle or pedestrian when first perceived?

• What was the progress of events, including locations, actions taken, speed changes, evasive maneuvers, horns sounded and so forth?

• Where were the impacts and where did the vehicles come to rest?

• What debris was seen and where?

• What skid marks were evident?

• What did anyone say about the accident and who said it?

• Were seatbelts on occupants of adverse vehicles?

• Did adverse vehicles have turn signals or headlights on?

• Area of damage of each vehicle?

About injuries

• What injuries were observed, bleading unconsciousness, shock, dazed, distortions of members?

• Were there any complaints of injury?

•  What if any injuries did you sustain?

• What treatment was rendered at the scene?

• By whom were injured parties removed from the scene?

About witnesses:

• Name, address and phone number?

• How were they identified?

• Location of the witness at the time of the accident?

About the police investigation:

• Names of officers and police department?

• What investigation was done?  

• What conversations were overheard?

• Was anyone cited or other disposition?

If statement in writing:

• Have interviewed driver read the statement and make corrections.  

• Corrections should be initialed.

• Conclusion stating the statement is true and correct to the best knowledge and belief.

• Signature of the driver.

• Identification and signature of any witness.

If recorded:

• Conclusion-- anything to add-- reiterate permission.

• State the time concluded.

• Ask permission to turn of recorder.

 

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