Accident Report

1. What type of Accident *

2. How did the accident happen *

3. Email - Confirm report *

4. What truck were you using

5. Could this accident have been preventable? Tell me how

6. File Upload (take a pic/receipt here)

7. Employee Name *

8. Cell Number

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9. Signed: *

10. Do we need to follow up on the Account, Accident, or Other?

11. When to follow up

12. What needs following up?

Accident Report

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