Accident Checklist

Below is a checklist of information you will need to collect after an accident or injury. You can print this document and keep a copy in your car or you can use it to put down any information that you gathered at the scene. If you have any questions, please contact a Los Angeles personal injury attorney at Carpenter, Zuckerman & Rowley, LLP.

If you would like a printable PDF of the document click here. Accident_Checklist.pdf

DATE OF ACCIDENT

DAY OF THE WEEK

TIME OF DAY

LOCATION OF ACCIDENT

VEHICLE

MAKE

MODEL

YEAR

LICENSE PLATE NUMBER

REGISTER OWNER OF VEHICLE NAME

OTHER PARTY(s) INFORMATION

NAME

ADDRESS

PHONE NUMBER

DRIVER’S LICENSE NUMBER

INSURANCE COMPANY

INSURED’S NAME

POLICY NUMBER

LOCATION OF DAMAGE ON VEHICLE

STATEMENT OF OTHER PARTY AT ACCIDENT

 
 

MY INFORMATION

LOCATION OF DAMAGE ON MY VEHICLE

(1) WITNESS NAME

ADDRESS
PHONE NUMBER

(2) WITNESS NAME

ADDRESS
PHONE NUMBER

 
POLICE INFORMATION

LAPD CHP OTHER POLICE REPORT NUMBER POLICE OFFICER NAME