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Event/Incident Online Report Form

Please ask these questions of the Driver Associate and complete the form accordingly.

It is extremely important that ALL questions be asked, and responses recorded.

THERE ARE THREE (3) SECTIONS TO THIS ONLINE FORM – ALL NEED TO BE COMPLETED

FOR YOU – BE CALM, PUT THE CALLER AT EASE, LISTEN CLOSELY, ASSURE DRIVER ALL IS OKAY

If the Police need/have been called, and/or a Member has been injured then, immediately following the completion of this online report, a call must be placed to the Manager on Duty. (Names and Mobile Numbers will be displayed once “SUBMIT” Button is hit.)

Section I – Status of Situation

Date of Incident*

MM slash DD slash YYYY

Time of Incident*

Hours

:

Minutes

AM/PM

Location*

Is everyone okay?*

Yes

No

Okay Comments

Is there a Member in the Car with you?*

Yes

No

Member in the Car Comments

Were you hit?*

Yes

No

Were you hit Comments

Is the damage to either car more than a superficial scratch and or minor bump?*

Yes

No

More than Minor Comments

Did you Call 911?*

Yes

No

911 Comments

Have the Police arrived?*

Yes

No

Police Arrived Comments

Can the vehicle be moved?*

Yes

No

Can the vehicle be moved Comments

Has the vehicle been moved?*

Yes

No

Has the vehicle been moved Comments

Section II – Documentation

Did you get a copy of their driver’s license, insurance card, and registration, and take pictures of all three?*

Yes

No

Get license, insurance, and registration Comments

Did you provide your driver’s license, our insurance card, and registration to the other driver(s) involved in the accident?*

Yes

No

Provide license, insurance, and registration Comments

Did you take photos of the accident scene, including many pictures of damage to either vehicle?*

Yes

No

Photos Comments

Did you get the Police Officer’s contact information (and take picture if possible)?*

Yes

No

Police Contact Info Comments

Please upload any images related to the incedent.

Drop files here or

Accepted file types: jpg, jpeg, gif, png, Max. file size: 5 MB, Max. files: 10.

Section III – HST Questions

Trip Number

Trip Origin

Leg of Trip

Driver Name*

First Last

Driver Phone*

Vehicle Number*

Member(s)

Add as many members as you need to by clicking the plus sign (+)

Member First Name

Member Last Name

Member Phone

Witness(es)

Add as many witnesses as you need to by clicking the plus sign (+)

Witness First Name

Witness Last Name

Witness Phone

Detailed description of Incident*

Dispatchers Comments

Any additional information that may be of assistance.

Who did you contact at GATRA*

Form Completed by*

Name

This field is for validation purposes and should be left unchanged.