Collision/Incident Information Form

    The Traffic Collision/Incident

    Please state your involvement in the collision?

    Your Location (I.e. Road, Motorway)

    Town Location

    County Location

    Collision/Incident Subject

    Describe the Collision/Incident in your own words

    Registration of Vehicle involved in Collision/Incident

    What date did the Collision/Incident take place?*

    What time did the Collision/Incident take place?*

    Was the traffic like?:

    Was the weather like?:

    Photos of Traffic Collision/Incident

    Photo 1

    Photo 2

    Your Details

    Your Name (required)

    Your Company

    Your Email (required)

    Your Telephone

    Any Injuries?

    If you were injured in the collision, please give details of your injuries:


    Would you like a copy of this report?*

    Are you willing to give your details to the Police?*