| Name | Description | Type | Additional information |
|---|---|---|---|
| Did the incident result in a fatality for company driver / passenger? | string |
None. |
|
| Were there any non-employees (other parties) injured as a result of the incident? | string |
None. |
|
| Did the incident result in a fatality for any parties involved (non-employees)? | string |
None. |
|
| Were any of the parties involved treated away from the scene (i.e., transported by ambulance from scene)? | string |
None. |
|
| Does this incident need to be reported to the Department of Transportation (DOT)? | string |
None. |
|
| Please identify DOT Reportable Type | string |
None. |
|
| Please provide any comments necessary for verifying DOT Reportable Classification. | string |
None. |
|
| Action Items Details | string |
None. |
|
| Last Driver Vehicle Inspection Report (DVIR) | date |
None. |
|
| Please identify if a chargeable accident for Company Vehicle: | string |
None. |
|
| Please select the expected payout / cost associated with the Vehicle Accident? | string |
None. |
|
| Please provide the total payout cost | integer |
None. |
|
| Comments | string |
None. |
|
| Action Items Details | integer |
None. |
|
| Action Items Details | string |
None. |