"Internal Vehicle/Equipment Incident Report" - Town of Clayton, New York

Internal Vehicle/Equipment Incident Report is a legal document that was released by the Finance Department - Town of Clayton, New York - a government authority operating within New York. The form may be used strictly within Town of Clayton.

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  • Released on July 29, 2021;
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VEHICLE/EQUIPMENT INCIDENT REPORTING POLICY
APPLICABILITY
This policy applies to all employees who work for the Town of Clayton who utilize Town-owned, leased
or personal cars, trucks, and other motorized equipment, including trailers and towed equipment while
performing the duties of their employment.
PURPOSE:
The purpose of this policy is to provide a concise record of incidents involving vehicles and related
equipment and to prevent additional accidents through effective use of follow up procedures. Failure to
comply with this policy will result in disciplinary action up to and including termination of employment.
A. REPORTING AN INCIDENT
Any incident, involving a Town vehicle or personal vehicle being used for Town business, regardless of
the extent of the damage, is to be reported to a police officer with jurisdiction in the area.
Drivers involved in an incident will use the Internal Vehicle/Equipment Incident Report to document the
event. Blank incident report forms will be kept in the glove compartment of each vehicle. Additional
copies are available for download online at www.townofclayton.com/hr.
B. PROCEDURE TO FOLLOW IN THE EVENT OF AN INCIDENT:
The following procedure will be followed when there is an incident involving a Town of Clayton vehicle,
including trailers or other mobile equipment, or a personal vehicle being used for Town business.
1. Stop vehicle, turn off engine, and use flashers or warning lights. If you are blocking a lane of travel,
move vehicle to side of road.
2. Call 911- even if there are no injuries. When the police arrive, cooperate and tell them what
occurred.
3. Assist any injured person, but DO NOT move them unless absolutely necessary to prevent further
injury. Otherwise, move to a safe place.
4. As soon as possible, the driver or a co-worker must immediately contact his/her supervisor to report
the incident and the status of all employees.
5. Supervisors, or their designee, will report to the scene of all incidents. Upon arrival, the supervisor
shall:
 view the scene of the incident
 interview the employee and
 take digital photos of the scene and personnel. Copies of the photographs will be attached to the
Vehicle/Equipment Internal Incident Report and become part of the record of the incident.
VEHICLE/EQUIPMENT INCIDENT REPORTING POLICY
APPLICABILITY
This policy applies to all employees who work for the Town of Clayton who utilize Town-owned, leased
or personal cars, trucks, and other motorized equipment, including trailers and towed equipment while
performing the duties of their employment.
PURPOSE:
The purpose of this policy is to provide a concise record of incidents involving vehicles and related
equipment and to prevent additional accidents through effective use of follow up procedures. Failure to
comply with this policy will result in disciplinary action up to and including termination of employment.
A. REPORTING AN INCIDENT
Any incident, involving a Town vehicle or personal vehicle being used for Town business, regardless of
the extent of the damage, is to be reported to a police officer with jurisdiction in the area.
Drivers involved in an incident will use the Internal Vehicle/Equipment Incident Report to document the
event. Blank incident report forms will be kept in the glove compartment of each vehicle. Additional
copies are available for download online at www.townofclayton.com/hr.
B. PROCEDURE TO FOLLOW IN THE EVENT OF AN INCIDENT:
The following procedure will be followed when there is an incident involving a Town of Clayton vehicle,
including trailers or other mobile equipment, or a personal vehicle being used for Town business.
1. Stop vehicle, turn off engine, and use flashers or warning lights. If you are blocking a lane of travel,
move vehicle to side of road.
2. Call 911- even if there are no injuries. When the police arrive, cooperate and tell them what
occurred.
3. Assist any injured person, but DO NOT move them unless absolutely necessary to prevent further
injury. Otherwise, move to a safe place.
4. As soon as possible, the driver or a co-worker must immediately contact his/her supervisor to report
the incident and the status of all employees.
5. Supervisors, or their designee, will report to the scene of all incidents. Upon arrival, the supervisor
shall:
 view the scene of the incident
 interview the employee and
 take digital photos of the scene and personnel. Copies of the photographs will be attached to the
Vehicle/Equipment Internal Incident Report and become part of the record of the incident.
Vehicle/Equipment Incident Reporting Policy
Page 2
6. The driver will complete the Internal Vehicle/Equipment Incident Report and give it to the
supervisor. If the driver is for any reason unable to complete the report at the scene, the driver will
give a verbal report to the supervisor, and complete the form in writing as soon as practicable.
 The Internal Vehicle/Equipment Incident Report and the police report number shall be provided to
the Town Supervisor's Office within 24 hours.
7. All Town employees involved in the incident must complete an Employee Incident Report (EIR) at
the scene of the accident whether or not an injury was sustained.
 The Employee Incident report shall be provided to the Town Supervisor's Office within 24 hours.
8. Supervisors, or their designee, are responsible for seeing that employees have completed the
Internal Vehicle/Equipment Incident Report and/or the Employee Incident Report as completely as
possible.
9. If a moving citation is issued to the driver, Human Resources must be notified as soon as practicable.
Commercial Motor Vehicle license holders must comply with the New York State DMV reporting
requirements.
10. If the driver holds a Commercial Motor Vehicle license and is operating a commercial motor vehicle
at the time of the incident, post-accident alcohol and controlled substance testing may be required.
Testing is required when an accident involves a fatality OR the driver receives a moving violation
citation arising from the accident AND 1) a vehicle must be towed, or 2) an injury requires
immediate medical treatment away from the scene. (Refer to the Town’s Employee Handbook and
the Union Bargaining Agreement for details.)
11. If the collision involves an unattended vehicle, the driver of the Town vehicle shall contact the
police immediately and, with their assistance, endeavor to contact the owner of the vehicle.
12. If the incident involves a hit and run, or the other party refuses to remain at the scene or provide
information, the driver of the Town vehicle should remain at the scene and contact the police in
order to document the details of the incident.
12. No repairs, appraisals or alterations to Town vehicles will be conducted without the
written authorization of the Town Supervisor's Office.
C. OTHER APPLICABLE POLICIES
Employees who utilize motor vehicles while performing the duties of their employment are also
subject to the rules and regulations outlined within the Town of Clayton’s Vehicle Use Policy, Driver’s
License Verification Policy, and, if applicable, the Commercial Motor Vehicle Driver Policy/Program.
Employees are required to familiarize themselves with all applicable vehicle policies.
7.29.21
INTERNAL VEHICLE/EQUIPMENT INCIDENT REPORT
Keep this in your glove box
First Steps
While Still At the Scene
Stop your car. If you are blocking a lane of travel, move
When the police come, cooperate and tell them what you
vehicle to side of road.
know.
Get aid for the injured- call 911 and ask for an
Take pictures.
ambulance.
Call the police- call 911 even if there are no injuries.
Notify your supervisor.
Day/Date/Time:
AM / PM (circle one)
Town Operator:
Title:
Equipment/Vehicle No.:
Your Passengers:
Location of Incident
(be specific):
Police Report Number:
DAMAGE DESCRIPTION (Don’t forget to take photos)
Your Vehicle:
Other Vehicle:
Circle the numbers closest to the damaged areas.
Circle the numbers closest to the damaged areas.
4
5
3
2
1
*CDL Drivers Only operating DMV at time of Incident
ALL DRIVERS
Is alcohol and controlled substance testing required?
Was there a fatality?
___ Yes ___ No
If yes- Test*
Were you issued a citation?
___ Yes ___ No
If yes- Go to next 2 questions
 Was a vehicle towed away?
If yes- Test*
___ Yes ___ No
*Alcohol within 2 hours, no more than 8 hours
post-accident.
 Was any one transported away from
If yes- Test*
*Controlled substance as soon as possible, no
the scene for medical treatment?
___ Yes ___ No
more than 32 hrs. post-accident.
 Who?
Driver
Co-worker
Other
Explain below how the incident happened:
Indicate on the diagram how the incident happened:
Employee’s Signature: ________________________________________
Date: ______________________________
Supervisor’s Signature: ________________________________________
Date: ______________________________
Director’s Signature: __________________________________________
Date: ______________________________
____ Copy Internal Vehicle/Equipment Incident Report to Town Supervisor ____ Copy of completed Employee Incident Report(s) to HR
____ Photos attached
7.29.21
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