MECHANICAL TRANSPORT ACCIDENT REPORT
1 At (Hrs) on ______(date) I was
informed by GS No______ Trade ________ Name ___________ of ________ (unit)
by ______ (media of information), that an accident had taken place at ______________(place
of accident). I was proceed immediately to the site of the MT accident for
preparing the accident report. I was accompanied by GS No _______ trade ___________
name _________________of ____________
(unit).
2 The details of the accident are as
under:-
(a) Place
of accident: ___________________________________
Date and Time of
accident: ____________________________
(b) Particulars
of the vehs involved in the accident:-
(i) Veh BA No ______ Make & Type_______
holding unit ________
(i) Other Veh No _______ Make & Type
_______Owner ________
(c) Particulars
of Drivers:-
(i) GS No _______ Trade ______ Name ____________
Unit________
and
License No & date _____________ Validity ________ LMV/HMV
(ii) Other vehs _____________________________________________
and License No &
date _______________ Validity _______ LMV/HMV
(d) Particulars
of passengers if any:-
(i) GS No ______Trade ______Name
__________ Unit _______
(ii) Other vehs ___________________________________________
(e) On what duty departmental veh proceeding
and by whose order _____________ (confiscate duty slip/car diary and
other documents if any and keep it separately)
(f) Whether departmental driver was in possession
of all documents _____________
(g) Weather/visibility at the time of
accident_____________________
(h) Condition of road surface at the time of
accident______________________
(j) Density of traffic at the time of
accident_____________________________
(k) Skid/scratch mark on
site___________________________________________
(l) Particulars of witness:-
Name Address Tele No Sig
(i)
(ii)
(m) Direction of approach:-
(i) Departmental veh from___________________
to __________________
(ii) Other veh from___________________ to __________________
(n) Speed of veh according to
driver/witnesses:-
(i) Departmental veh __________Km/H
(ii) Other veh __________Km/H.
(o) Whether the vehs on correct side of
road:-
(i) Departmental veh __________
(ii) Other veh __________
(p) Whether warning of hand signals were
given:-
(i) Departmental veh __________
(ii) Other veh __________
(q) Action taken to avoid accident:-
(i) Departmental veh __________
(ii) Other veh __________
(r) Particulars of the personnel injured:-
(i) Departmental veh __________
(ii) Other veh __________
(s) Damages to vehs
(i) Departmental veh __________
(ii) Other veh __________
(t) Details of broken pieces (exhibits to
be collected)
(u) Condition of the vehs (Tyre___ Brake____
steering____ light____ wiper ____)
(v) Action taken to inform Civil police /
CMP /FIR No and date_________________
(w) Cause of accident (most
likely)______________________________________
(x) Casualties if any:-
GREF Dead (i) _________________ Injured (i) ___________________
Other Dead
(i) _________________ Injured
(i) ___________________
(y) Any useful
information:-_______________________________________
(z) The following documents are enclosed:-
(i)_____________________________ (iv)_________________________
(ii)_____________________________
(v)_________________________
(iii)_____________________________
(vi)_________________________
Witness:- Prepared
by
I corroborate the above statement.
Sig ___________ Sig
___________
GO/GS No ______Trade______ GS
No ______Trade_____
Name __________________ Name __________________
Unit____________________ Unit____________________
Date ___________________ Date ____________________________________________
