Page 199 - Personnel Policy and Procedures Manual

FLEET ACCIDENT REPORT
Form RM-FAR Augusta, Georgia
Date of Accident - Day of the Week Time - No. of vehicles involved - Case No.
- Augusta Private
Location/ Address - Intersection  Augusta, Georgia Outside Augusta, Georgia

Augusta VEHICLE OTHER VEHICLE

Drivers Last Name - First Drivers Last Name - First

Department Dept # - Address - Phone

Dept Address - Phone City State Zip Code
-

License # - State - Class - Expires Drivers License # - State Class DOB
- -

OWNER INFORMATION OWNER INFORMATION

Augusta Commission Same as Owners Last Name First
Driver

Room 217, Augusta, Georgia Building Address -

530 Greene Street City State ZIP Phone
Augusta, GA 30911 (706) 821-2301

VEHICLE INFORMATION VEHICLE INFORMATION

Year Make - Model - Odometer Year Make - Model - Odometer
- -

License Plate No. Asset No. Vehicle License Plate No - State - Year Color -
No. -

VIN Number - Driver Cited - Owners Phone No. Driver Cited -
 Yes  No  Yes  No

INSURANCE INFORMATION INSURANCE INFORMATION
Insurance Co. and/or Agency - Insurance Co. and/or Agency -
Augusta Commission
Policy No - Policy No -
Risk Management Department (706) 821-2301

Vehicle Removed by -  Towing Driven from Vehicle Removed by - Towing Driven from
scene scene

Number of Injuries to Employees________ Number of injuries to Private Citizens -_________
Submitted By - Reviewed By -

Job Title - Job Title -

All Rights Reserved – As approved by the Commission on 05-07-2019 198 | P a g e