Incident Report

Contact Info

Our Office

5398 Market Street
Kalamazoo, MI 49048


Open Office Hours

M-F: 8am – 5pm


Get in Touch

P: (269) 344-3341
Fax: (269) 344-7100

All incidents must be reported WITHIN 2 HOURS

Complete this form entirely and truthfully for all personal injury or vehicle damage, property damage and freight issues. Submit to immediate supervisor upon completion. If more space is needed, please attach a separate page.

Incident Report

Type of Incident

Was the employee injured?

Was first aid given?

Any other persons injured?

Was first aid given?

Any medical attention (other than first aid)?

If employee was involved in a vehicle accident, please complete the following.

Police called?

Did our vehicle need to be towed?

Any other vehicles involved?

Any damage to other vehicle(s)? If yes, TAKE PICTURES

Did other vehicle need to be towed?

Did employee exchange insurance information with other driver?

Did employee complete the accident report kit? (Fax accident report to 269-344-7100)

Any damage to surrounding property? (If yes, TAKE PICTURES)

Any missing freight?

Any damage to freight? (If yes, TAKE PICTURES)

By completing this form and checking this box, you are verifying the accuracy and completeness of this form.