DSTRILOGIX manages 5 data types including driver carrier assignments. Helps you organize, track, and share your work in 1 place for teams and solo users.

Company Accident Investigation and Accident Register Entry

Internal safety form for documenting vehicle accidents, performing investigations, and maintaining the accident register in compliance with 49 CFR 390.15.

Full Name*

Phone Number*

Email Address*

Company Accident Investigation and Accident Register Entry

Event Classification

Internal Incident ID

Driver / ID

Load Number

Date

Time

Location

Federal accident criteria

Fatality

Bodily Injury Requiring Immediate Treatment Away from Scene

Vehicle Towed Due to Disabling Damage

Does Not Meet Definition

Accident Register required?

Yes

Register Data

Driver Name

Number of Injuries

Number of Fatalities

Hazardous materials released other than fuel from vehicle tanks?

Yes

Investigation

Investigator

Investigation Start

Completed

Evidence reviewed

Root cause and contributing factors

Preventability determination

Preventable

Non-Preventable

Undetermined

Corrective actions, training, discipline, or system changes

Notifications and Closure

Party Notified (1)

Date / Time (1)

Contact (1)

Reference (1)

Party Notified (2)

Date / Time (2)

Contact (2)

Reference (2)

Safety Reviewer

Signature

By typing your name, you are electronically signing this document.

Closure Date