VEHICLE ACCIDENT REPORT
Last Revision: 05/12/2005

VEHICLE ACCIDENT REPORT

Table of Contents:


Purpose:

The Vehicle Accident Report form is used to record facts of any accident involving a University vehicle, rental car or personal vehicle if being used on University business. Complete this form in its entirety and email it to PSUClaims@psu.edu along with photos of the vehicles involved, including the damage and license plate, as well as photos of the scene if pertinent. Commonwealth Campuses please email to PSUClaims@psu.edu and provide a copy to your Director of Business and Finance Services. All information on this form is important and must be obtained at the time of the accident. If for some reason (such as injuries) all the information cannot be secured immediately, the form must be submitted as soon as possible, within 24 hours.

General Information:

NOTE: This form has digital IDs (electronic signature) fields enabled. If completing the form electronically, please complete the entire form BEFORE obtaining any signatures. Once the first signature is applied to the form, the Adobe Acrobat software considers the form "approved" and no further revisions may be made to the form (other then adding additional signatures).

Every employee driver must complete this form no matter how minor the accident.

All information called for on this form is important and, generally, can best be obtained at the time of the accident. If for some reason (such as injuries) all the facts cannot be secured immediately, the form must still be submitted as soon as possible to Risk Management within 24 hours. On the basis of the completed form submitted, the Risk Management Office can then, in turn, file the required accident report with the insurance company.

If you are involved in an accident in which someone is injured or a death occurs, or if any vehicle is damaged to the extent that it cannot be driven, you must immediately notify the local or state police.

Exhibit and Instructions:

The employee driver must complete the entire form, answering all the questions, and sign the form in the designated space as soon as possible within within 24 hours.

The employee's supervisor or department head must sign the form, verifying that the accident was properly reported and the vehicle was authorized for a permissible use.

To view document exhibit, click on link belows:

Vehicle Accident Report Exhibit

Form Requirements:

No form may be used that substitutes for an approved official University form without prior review and approval by the steward of the form/central office, as facilitated by the Office of Systems and Procedures (designated representative of the Associate Vice President for Budget and Finance). See Policy FN17 Required Use of Approved University Forms Appearing in the General University Reference Utility (GURU) and Procedure FN2017 Use of Approved Forms Appearing on the GURU Website for full details.

If you encounter any difficulties, contact the GURU support staff by submitting a Technical Support Request form.

Number of Copies and Ultimate Distribution:

Table of distribution and retention of the Vehicle Accident Report
Document: Ultimate Distribution: Retention Periods: Disposition Method:
Original Risk Management Office (PSUClaims@psu.edu) End of fiscal year +2 years Paper documents = Secure Bin disposal or shred beyond recover
Electronic document and data = Delete from computer and empty computer recycle bin

Where to Send Completed Forms:

Complete this form in its entirety and email it to PSUClaims@psu.edu along with photos of the vehicles involved, including the damage and license plate, as well as photos of the scene if pertinent.

Commonwealth Campuses please email to PSUClaims@psu.edu along with photos of the vehicles involved, including the damage and license plate, as well as photos of the scene if pertinent. Provide a copy to your Director of Business and Finance Services.

Contact Information:

For questions, additional detail, or to request changes to this form, contact Risk Management

Cross References: