DOT Accident Incident Report

PURPOSE:

To ensure that all employees promptly and accurately report all incidents, accidents, and near misses. To ensure that all supervisors promptly and thoroughly investigate all accidents. To ensure that the root causes of all incidents and accidents are corrected in a timely manner. These are all accidents that would be DOT related (Trucking).

OBJECTIVE:

To document all accidents or incidents to determine root cause to prevent any reassurances. Also, to be able to share with other Robert Collins Company locations to help promote a healthy safety culture.

Employee Injuries

All Robert Collins Company employees will report any injury no matter how miner. An initial accident report must be
filled out by their supervisor immediately and signed by the employee. The initial report must be sent to the safety director
within 24 hours of the incident. An investigation of the incident will be conducted, and pictures will be taken. All
documentation associated with the investigation will be documented or attached to the report. A copy of the completed
accident report will be sent to the Safety Director, ROBBY COKER, once a complete investigation has been done.
If additional information needs to be collected or the determination of the root cause has not been completed.
The initial accident report still needs to be completed and sent to the safety director.


Any additional information will be sent upon completion of the investigation.


If an employee requires outside medical treatment make sure to contact your area manager and the safety director. If the
employee is unable to drive themselves, contact an ambulance.


Once the employee is taken off site to see a doctor a non-DOT drug/alcohol screen is required.

Near Misses:

Near misses is a tool to use to help gauge our safety programs as well as to share valuable information within our company. These reports can help the operations to prevent recurrences at their sites. 

Any near miss with equipment or people should be reported to supervision. An accident report will be filled out with as much detail as possible and an action plan will be developed on how to prevent this near miss from happening again. Once complete, it will be sent to your area manager and safety director. These documents could be used in safety meetings or safety talks within Robert Collins Company. 

Equipment / Property Damage

All equipment or property damage must be reported immediately to your supervisor. Reports must be filled out just like an employee injury or near miss. If multiple employees are involved, then separate accident forms will be filled out for each employee involved. A copy of all documentation including pictures will be sent to your area manager and safety director. If the property damage will exceed $10,000 a call should be made to your area and manager and safety director as soon as possible. All employees involved with property damage will be taken for a post-accident non-DOT drug and alcohol screen.

Accident Incident Reporting DOT

First, Middle, Last - TITLE

DRIVER INFORMATION

First, Middle, Last
Division

(town, city, state)
(route #, street, hwys.)
(using one or two sentences)

DEATH AND INJURY

Fatalities or Injuries :
Was there anyone else company vehicle at the time of the accident? :
Damage to COMPANY vehicle? :
Damage to OTHER vehicles? :
Wecker Involved? :
Damage to cargo? :
Were hazardous materials, other than fuel spilled from the fuel tanks of vehicles involved in the accident, released? :
If YES, describe:

COMPANY VEHICLE INFORMATION:

Vehicle:

OTHER VEHICLE / PROPERTY INFORMATION:

ROADWAY INFORMATION:

Accident occurred on number of lanes:
Visibility:
Highway:

Type of Roadway 1 :

Type of Roadway 2 :

Type of Roadway 3 :

Type of Roadway 4 :

Type of Roadway 5 :

ACCIDENT / INCIDENT DRIVER EVALUATION

Preventable or Non-Preventable :
Drug Test Completed? :
Alcohol Test Completed? :
Previous Vilations? :
Previous Accidents? :

DRIVER STATMENT

MM slash DD slash YYYY