Vehicle Damage Report

Damage reports are used by drivers and fleet managers to support insurance claims. The report documents information regarding the vehicles and parties involved, details of the accident, and the extent of the damage. When in doubt, fill it out!

Person Completing Vehicle Damage Form(Required)

First Last

Crew Contact Information(Required)

Personal Number? Crew Phone Number?

WisCorps Vehicle information(Required)

License Plate, Make & Model

Other Vehicle(s) Involved?(Required)

License Plate, Make & Model

Date of Damage/Accident(Required)

What day did the damage take place? When was the damage first noticed?

Time of Damage/Accident(Required)

At approximately what time did the damage take place? When was the damage first noticed?

Damage Description(Required)

Describe Activities of Employee When Damage or Accident Occurred and What Tools, Objects, Were Involved. Describe the Damage.

What Happened to Cause This Damage or Accident?(Required)

(Describe How The Damage Occurred)

Injury Photo #1

Max. file size: 50 MB.

Injury Photo #2

Max. file size: 50 MB.

Did this injury occur because..

(check any that apply)

Substance abuse

Failure to use safety devices

Failure to obey rules

CAPTCHA

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