Accident Report Form 88
Accident Report Form 88
Accident Report Form 88
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THE INFORMATION CONTAINED ON THIS PAGE IS CONFIDENTIAL ATTORNEY-CLIENT AND WORK-PRODUCT INFORMATION. THIS<br />
INFORMATION SHALL BE SUBMITTED TO AND RETAINED BY THE CITY ATTORNEY'S OFFICE.<br />
PART IV- WITNESSES<br />
NAME ADDRESS BUS. PHONE NO. (ext.) PHONE NO. (residence)<br />
PART V- INJURIES<br />
NAME OF PERSON(S) CLAIMING INJURY ( Address) (Phone) (Sex) (Age)<br />
PART VI- DESCRIPTION OF ACCIDENT<br />
L.A.P.D. INVESTIGATION<br />
YES<br />
NO<br />
NAME OF OTHER INVESTIGATING POLICE DEPARTMENT (If no investigation, indicate "NONE")<br />
DIRECTION CITY VEHICLE WAS TRAVELING STREET SPEED SPEED<br />
TRAFFIC CONTROL<br />
WAS TRAFFIC CONTROL OBEYED<br />
NONE STOP SIGN SIGNAL OTHER (Specify) YES NO<br />
DIRECTION OTHER VEHICLE WAS TRAVELING STREET SPEED SPEED LIMIT<br />
TRAFFIC CONTROL<br />
WAS TRAFFIC CONTROL OBEYED<br />
NONE STOP SIGN SIGNAL OTHER (Specify) YES NO<br />
WEATHER CONDITION<br />
VISIBILITY<br />
DAY NIGHT GOOD POOR<br />
Describe the facts of the accident in detail.<br />
DIAGRAM OF ACCIDENT<br />
LEGEND<br />
CITY VEHICLE<br />
OTHER VEHICLE<br />
EMPLOYEE SIGNATURE<br />
DATE<br />
SUPERVISOR'S COMMENT<br />
SUPERVISOR'S SIGNATURE<br />
DATE<br />
<strong>Form</strong> Gen. <strong>88</strong> (Rev. 1/06) PAGE 2<br />
GO PAGE 1<br />
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