Risk Management

In Case of Accident

1.  Aid the Injured

Do not move injured individuals unless absolutely necessary!  Warn other drivers.

2. Call the Police

Give exact location and advise if medical help is needed.   Write down the name and badge numbers of the police officers who assist you.  Are they state or local police?

____________________________________________
Location of  Accident 

____________________________________________
City

____________________________________________
Name of Officer                                 Badge #

____________________________________________
Name of Officer                                 Badge #

____________________________________________
Was Summons Issued?                     To Whom?

3. Record Facts About State Vehicle

Complete all information concerning the state vehicle.

____________________________________________
Date of Accident                                     Time   AM/PM

___________________________________________
Department/Division/Section

___________________________________________
Driver's Name                                    Social Security #

___________________________________________
Address

___________________________________________
Address                                             Phone #

___________________________________________
Year of Vehicle/Make/Model             License Plate #

___________________________________________
Nature of Damage

4. Obtain Facts About Other Vehicles

It is important to get the name, address, and driver's license number of other driver(s) involved.

1) ________________________________________
    Name                                             Phone

    ________________________________________
    Address

    ________________________________________
    Year of Vehicle/Make/Model             License Plate #

    ________________________________________
    Insurance Company

    ________________________________________
    Nature of Damage

2) ________________________________________
    Name                                             Phone

    ________________________________________
    Address

    ________________________________________
    Year of Vehicle/Make/Model             License Plate #

    ________________________________________
    Insurance Company

    ________________________________________
    Nature of Damage

5. Obtain Facts About Injured Persons

It is important to obtain the name, age, address, and nature of injury of anyone injured.

1) ________________________________________
    Name                                                     Age

    ________________________________________
    Address

    Injured was:    ___ In my vehicle       ___ In other vehicle      ___ Pedestrian

    ________________________________________
    Nature of Injury

2) ________________________________________
    Name                                                     Age

    ________________________________________
    Address

    Injured was:    ___ In my vehicle       ___ In other vehicle      ___ Pedestrian

    ________________________________________
    Nature of Injury

6. Record Facts About Other Property Damage (Non-Vehicular)

Complete all information concerning damage to other property.

____________________________________________
Owner                                                     Phone

____________________________________________
Address

____________________________________________
Address

____________________________________________
Object Damaged

____________________________________________
Nature of Damage

7. Get Witnesses

Get the name and address of all available witnesses to the accident.

1) __________________________________________
    Name                                                 Phone

    __________________________________________
    Address

2) __________________________________________
    Name                                                 Phone

    __________________________________________
    Address

8. Call Risk Management (573) 751-4044

Within 24 hours of the accident.

9. Give out only that information required by law authorities.

Do not make any statement concerning the assumption of liability.  Give out only that information required by authorities.   Do not sign any statement except for an authorized representative of the Risk Management Section.

10. Automobile Loss Notice

Complete in full an Automobile Loss Notice Form #MO 300-0068 and forward it along with a copy of the police report and this form to Risk Management within 2 days (see address given below).

Describe the Accident!

Attach a separate sheet of paper by drawing a complete diagram of the area showing your vehicle and all other vehicles involved. 

City __________________________    State____________

Street Name or Highway Number_____________________

Mail all of this information with a completed Automobile Loss Notice form to:

Office of Administration
Risk Management Section
P.O. Box 809
Jefferson City, MO 65102

This page may be printed off and placed in the glove compartment of the car you are operating to help you in case of an accident.