Campus Vehicle Repair Form

Accident & Damage Information

Date of Damage/ Accident:

Time of Damage/Accident:

Hilbert Driver Name:

Hilbert Driver Date of Birth:

Hilbert Driver's Phone Number:

Hilbert Driver's Email Adress

Hilbert Driver Address:

City:

State:

Zip:

Were there any injuries?

No, there were no injuries

Yes, there were injuries

Was the campus vehicle required to be towed?

No, the campus vehicle was not require to be towed.

Yes, the campus vehicle required towing.

Were other vehicles involved?

No, only the campus vehicle was involved.

Yes, other vehicles were involved.

Were any of the other vehicles involved required to be towed?

No, the other vehicle(s) did not need to be towed.

Yes, the other vehicle(s) did need to be towed.

If other vehicles were involved, was information exchanged?

No, information was not exchanged.

Yes, information was exchanged.

Describe the event that caused the accident and/or damage, and describe the damage to the vehicle(s) involved:

Were the police notified?

No, the police were not notified.

Yes, the police were notified.