| Name | Description | Type | Additional information |
|---|---|---|---|
| Year of Vehicle | string |
None. |
|
| Make of Vehicle | string |
None. |
|
| Model of Vehicle | string |
None. |
|
| VIN Number | string |
None. |
|
| License Tag Number | string |
None. |
|
| State of License Plate Tag | string |
None. |
|
| Trailer (if Applicable) | string |
None. |
|
| Model of Trailer | string |
None. |
|
| Damage to Company Vehicle? | string |
None. |
|
| Please describe damage to vehicle | string |
None. |
|
| Was vehicle towed as a result of the incident? | string |
None. |
|
| Please explain who towed the vehicle? | string |
None. |
|
| Address / Location of Incident / Cross Section | string |
None. |
|
| Vehicle City | string |
None. |
|
| Vehicle State | string |
None. |
|
| Did incident occur within a construction zone? | string |
None. |
|
| Please select scenario that best represents traffic / road condition? | string |
None. |
|
| Please select scenario that best represents the weather conditions at the time of the incident? | string |
None. |