Procedure: 7-81 |
Effective: 7/1/2014 |
Owner: Office of Property & Liability Risk Management |
Latest Revision: |
Completing Automobile Loss Notice
Scope | System References | Policy | Responsibility | Distribution | Ownership
To report vehicle accidents or claims for either state vehicles or rental vehicles used for University business System References [Top] Claim information inside each University owned vehicle Office of Property & Liability Risk Management 2400 Old Ivy Rd., Suite 181 Charlottesville, VA 22904 (434) 924-3055 http://www.virginia.edu/riskmanagement/ Policy [Top] PRM-014 Use and Management of University-Owned Vehicles Responsibility [Top] All accidents involving state vehicles or rental vehicles used for University business must be reported to both the State Police and the Office of Property & Liability Risk Management. Distribution [Top] All Departments Ownership [Top] Office of Property & Liability Risk Management Procedure Steps [Top] INSTRUCTIONS FOR COMPLETING AUTO LOSS NOTICE TIME AND PLACE OF ACCIDENT: Date, time, and specific address of accident. ABOUT YOUR AUTO: Make, Year, Model, VIN of vehicle, License Plate # Name of driver, driverÕs home address DriverÕs phone number and hire date. Dept., SupervisorÕs name, Sup. Phone number DriverÕs date of birth, DriverÕs lic. # was it in effect?, DriverÕs title Where were you going when accident happened? Where were you coming from? Business or Pleasure? Who gave permission - SupervisorÕs name, & title, Purpose of use Description of all damages to vehicle, detailed. Where is the vehicle now? (Repair shop, dept.?) Estimated cost of repairs (rough idea) OTHER AUTO INVOLVED: Enter other vehicle involved information in this section, as well as contact information for other driver/owner and insurance information. PASSENGERS: List passengers in state vehicle and other involved vehicle INJURIES: List any injuries of state employee, other involved driver, and passengers. WITNESSES: List any witnesses to the accident. PROPERTY DAMAGE OTHER THAN AUTO: To be completed when state vehicle causes damage to non-auto property (i.e., truck hitting overhang of building). DESCRIPTION OF ACCIDENT: Complete section to the best of your ability. Did Police Investigate Accident: Were police called? Police Agency: Which agency responded (i.e., State, UVA, County)? GLASS BREAKAGE: Complete this section for any glass breakage to the state vehicle. DATE OF REPORT: Date report filed. REPORTED BY: Person completing form. If you should have any questions regarding the completion of this form, contact Property & Liability Risk Management at (434) 924-3055. End of Activity |
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