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0TIE- <br /> �. On�I foul Inl!(,rtW Entwpr{M <br /> VEHICLE ACCIDENT REPORT <br /> Page 1 of 3 <br /> ACCIDENT DESCRIPTION <br /> Accident Date Time: <br /> Location: City, State <br /> Description of Accident: <br /> Witness: Telephone No: <br /> Address: <br /> Police Officer: Department: <br /> ❑ Passengers? YES ❑ or NO ❑ i Weather: Circle One <br /> ❑ Injuries? YES ❑ or NO ❑ Clear Cloudy Fog Rain Sleet Snow <br /> Other: Describe <br /> ❑ Pavement: Circle One ❑ Conditions: Circle One <br /> Asphalt Steel Concrete Wood Dry Wet Icy Pot Holes <br /> Gravel/Dirt Brick Other: Describe <br /> Other: Describe <br /> Roadway: Circle One ❑ No. of Vehicle towed from scene: <br /> Residential Divided Highway Undivided ❑ Number of Injuries <br /> Highway ❑ Number of Fatalities <br /> No. of lanes in each direction: <br /> Were Hazardous Materials Released? YES F-7 or NO If YES, describe materials: <br /> Was vehicle accident report sent or called into an OTIE office? YES or NO ❑ <br />