Name:____ Name of Witness___
Date of incident:___The date the accident occurred on____
Approximate time:_____ it is an estimate, the witness is trying to recall the time from memory._____
Location of intersection: ___Main &College____
Where were you when the accident occurred:___ On main_____
Special conditions:___No___
Approximate speed: ___60____
Were there any obstructions to the drivers view:___ No__
Who do you consider at fault:__ the witnesses point of view___
Describe in depth what you remember before, during, or after the incident:____ the main purpose of this is that the witness gives as many details of the accident, it helps with the police report and any insurance claims._________________
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