CITY OF LONDON POLICE

Road Traffic Collision/Accident

Self Reporting Scheme

The purpose of this form is to reduce the inconvenience to you. Police staff are sometimes not immediately available to record details of your collision/accident and you could otherwise face a lengthy wait. Your cooperation also releases more officers for street patrol. However, if you have any queries concerning the collision/accident or the completion of the proforma then please do not hesitate to ask the station reception officer. Also, by completing the proforma at the station now and immediately returning it to the reception officer, you have complied with the legal obligations following a collision. This is provided that you have attended the police station as soon as practicable after the collision/accident and in any case within 24 hours of it taking place. Please remember that if a vehicle has failed to stop, our enquires are likely to take at least 28 days and maybe protracted due to the requirements of Road Traffic Legislation. We are constantly examining ways in which we can improve the quality of service to the public and I hope you find this system helpful. Divisional Commander

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Road Traffic Collision/Accident Report

Please complete in black ink Tick boxes as applicable

Instructions for person reporting collision/accident:

• Please complete the form and ensure that it is handed directly to the Station Reception Officer.

• Please answer all questions or delete where appropriate.

• If you are unable to complete this form please ask for assistance.

Is the accident being reported for insurance purposes only? Yes No

Are you willing to attend court if necessary? Yes No

Has any person received any injuries as a result of this collision/accident? Yes No

If ‘Yes’, please give details:

A. Details of the Collision/Accident

Date of collision/accident: Time:

Location of collision/accident:

Your name: (*Mr/Mrs/Miss/Ms) Date of birth:

Private address: Post code:

Business address: Postcode:

Telephone No.: Telephone No.:

B. Description of your vehicle

Make and Model: Colour:

Registration Mark: Plate No. (if cab):

Are you the owner of the vehicle? Yes No

If ‘NO’, please state the name and address of the registered Keeper:

Details of damage to your vehicle:

C. Witnesses

Please give names, addresses and telephone numbers.

State whether witnesses are independent or passengers in a vehicle involved.

D. Please state briefly what happened

Weather conditions: *Sunny Dry Overcast Raining Snowing Windy

Road conditions: *Dry Wet Icy Uneven road surface

Visibility conditions: *Clear Foggy Daylight Dusk

Street-lighting (please state whether) ON OFF

E. Other vehicles Involved (if known)

1. Name: (*Mr/Mrs/Miss/Ms) Address: Telephone Number: Vehicle Registration Mark: Make, Model and Colour:

Damage:

2. Name: (*Mr/Mrs/Miss/Ms) Address: Telephone Number: Vehicle Registration Mark: Make, Model and Colour:

Damage:

F. This section needs to be completed if the other driver(s) involved in the collision/accident failed to stop and/or exchange particulars of Name, Address and Vehicle Registration Mark

How load was the sound of the collision/accident? *Inaudible Clear Loud Very loud

Did the other driver stop at all? *YES NO

If ‘Yes’, describe what he or she did, e.g. sat in car, got out of car, stopped for a moment and then drove off, etc.

If ‘NO’, give reason why believe the other driver knew a collision/accident had occurred, e.g. by turning his/her head and accelerated away quickly, other vehicle sustained damage at the front, etc.

Was there any conversation between you and the other drive? YES NO

Did you ask the other driver for his/her name and address? YES NO

If ‘YES’ was it? Supplied Refused Request ignored

Did police attend the scene whilst you were still there? YES NO

If ‘Yes’, had the vehicles been moved before the police arrived? YES NO

Was the registration mark of the other vehicle recorded by you at the time of the collision? YES NO

If ‘NO’, provide the name and address of the person who recorded the registration mark of the other vehicle at the time of the collision/accident.

NB: The original note of the registration mark of the other vehicle is an important exhibit and if it has not been handed in with the report, it must be retained in a safe place and kept for production in court if required.

Describe briefly the other driver involved in i.e. gender , age, height, build, eye colour, hair, complexion and any other distinguishing features. Say whether you would be able to identify the other driver.

Please complete section G

I understand that without the full registration number, Police may not be able to take further action.

When completed, please hand back personally to the Station Reception Officer.

I hereby declare that the information given on this form is true to the best of my knowledge and belief, and I give it knowing that if it is tendered in evidence I shall be liable to prosecution if I have wilfully in it stated anything which I know to be false or I do not believe to be true. (C.J. Act, 1967, S.9 Mag. Ct. Act 1980, SS.5A(3)(A) and 5B, M.C. Rules 1981 S.70)

Signature of person reporting:………………………………………………………………………………………………………………………………………………………

Witnessed by:…………………………………………………………………………………………………………………………………………………………………………(SRO)

G. Plan of Collision/Accident

Please draw a sketch of the collision/accident showing positions of vehicles, direction of travel, road signs, crossings, bollards, etc. It would be helpful if you could indicate NORTH.

This section is to be completed by the Station Reception Officer or the Station Officer.

Name:……………………………………………………………….. Signature:………………………………………………………………………

Rank/Title………………………………………………………….. Date:……………………………… Time:……………………………………

Did you check the damage to the vehicle shown in Section B? YES NO

If ‘YES’, give details of the damage seen

I.D. codes of: Person(s) injured: 1 2

1 2

Was an ambulance called? YES NO Time of arrival:

Injured person conveyed to:……………………………………………………………………………………………………………………………………………………………

Person injured: *Pedestrian, Driver, Rider, Pillion passenger, Passenger in vehicle. No…………………(front/rear seat)

Name: Date of birth/Approx. age Male Female

Address:

Telephone No.: Nature of injury:

If child casualty (aged 5-16) school attended

On journey to or from school? YES NO

Produce your Driving Licence, and insurance on returning form to Police Station

Driving Licence Insurance MOT

Correct: Yes/No Correct: Yes/No Correct: Yes/No

Driver No: (Type of licence) Policy No.: Serial No.:

Issue No.: Issued by: Date of issue:

Expiry Date: Date of issue: Expiry date:

Full/Provisional Expiry date: Name and address of testing station:

Old/New Tel No.: (of available)

Categories/Group No. of testing station

HO/RT1 to be produced at: NB: HORT/1 to be issued by a Police officer

Criminal Justice Unit only: Action:……………………………………………………………………………………………………………………………………..

NFA (if documents correct):………………………………………………………….PA…………………………………….

Scene Details: All sections must be completed by the checking officer for ALL COLLISIONS/ACCIDENTS by entering the appropriate number in box

Vehicle Record Enter vehicle number: Vehicle Record (continued)

Type of vehicle Object in carriage way hit

01 Pedal cycle 02 Moped 03 Motorcycle 125 c.c. and under 04 Motorcycle over 125 c.c. 08 Taxi 09 Car 10 Minibus (8-16 passenger seats) 11 Bus or coach (17 more passenger seats) 14 Other motor vehicle

15 Other non-motor vehicle 16 Ridden horse 17 Agricultural vehicles 18 Tram/light rail 19 Goods vehicle 3.5 tonnes maximum gross weight (mgw) & under 20 Good vehicle over 3.5 & under 7.5 tonnes mgw 21 Goods vehicle 7.5 tonnes & over

00 No object hit 01 Previous accident 02 Roadworks 03 Parked vehicle lit 04 Parked vehicle unit 05 Bridge (Roof) 06 Bridge (side) 07 Bollard/refuge 08 Open door of vehicle 09 Central island of roundabout 10 Kerb 11 Other object

Towing and articulation Object in carriage way hit

0 Not towing/articulated 1 Articulated vehicle 2 Double/multiple trailer 3 Trailer caravan 4 Single trailer 5 Other tow

00 No object hit 01 Roadside/Traffic signals 02 Lamp post 03 Telegraph/Electricity post 04 Tree 05 Bus stop/Shelter

06 Central crash barrier 07 Nearside/offside barrier 08 Submerged 09 Entered ditch 10 Other permanent object

Enter appropriate code Nos. in boxes Casualty No. 1 2

Manoeuvres If pedestrian casualty

01 Reversing 02 Parked 03 Held up 04 Stopping 05 Starting 06 U-Turn 07 Turning left 08 Waiting to turn left 09 Turning right

10 Waiting to turn right 11 Changing lane to left 12 Changing lane to right 13 Overtaking on offside moving vehicle 14 Stationary vehicle 15 Overtaking on nearside 16 Going ahead – L hand bend 17 Going ahead – R hand bend 18 Going ahead – other

1. LOCATION 01 In carriageway, crossing on pedestrian crossing 02 In carriageway, crossing on zig-zag lines approach 03 In carriageway, crossing on zig-zag lines exit 04 In carriageway, crossing elsewhere within 50 metres (55 yards) of pedestrian crossing

05 In carriageway, crossing elsewhere 06 On footpath or verge 07 On refuge or central island or reservation 08 In centre of road, not on refuge or central island 09 In carriageway, not crossing 10 Unknown

Vehicle location 2. MOVEMEMENT

01 Leaving the main road 02 Entering the main road 03 On the main road 04 On the minor road 05 Tram/Light rail

06 On lay-by/hard shoulder 07 Entering lay-by/hard shoulder 08 Leaving lay-by/hard shoulder 09 On cycleway 10 Not on carriageway

1 Crossing from driver’s nearside 2 Crossing from driver’s nearside masked by parked or stationary vehicle 3 Crossing from driver’s offside 4 Crossing from driver’s offside masked by parked or stationery vehicle

5 In carriageway not crossing (standing or playing) 6 In carriageway not crossing (standing or playing) masked by parked or stationery vehicle 7 Walking along in carriageway facing traffic 8 Walking along carriageway back to traffic 9 Unknown

Vehicle location at first impact 3. PEDESTRIAN DIRECTION

0 Not at or within 20 metres of junction 1 Approaching junction / parked at junction 2 Vehicle in middle of junction 3 Cleared junction / parked at junction exit 4 Did not impact

Compass point bound: 1. N 2. NE 3. E 4. SE 5. S 6. SE 7. W 8. NW

Skidding IF DRIVER OR PASSENGER CASUALTY

1 Not applicable 2 Skidded and overturned 3 Jack-knifed

4 Jack-knifed and overturned 5 Overturned

4. SEAT BELT USAGE 1. Safety belt in use 2. Safety belt not in use 3. Safety belt not fitted

4. Child safety belt/harness in use 5. Child safety belt/harness fitted – not in use 6. Child safety belt/harness not fitted 7. Unknown

First Point of Impact (Use one code only) IF P.S.V PASSENGER CASUALTY

0 Did not impact 1 Front 2 Back

3 Offside 4 Nearside

5.

1. Boarding 2. Alighting

3. Standing passenger 4. Seated passenger

Vehicle leaving carriageway (i.e. one wheel at least leaving)

0 Did not leave carriageway 1 Left carriageway – nearside 2 Left carriageway – nearside and rebounded 3 Left carriageway straight ahead at junction 4 Left carriageway on to central reservation

5 Left carriageway on to central reservation and rebounded 6 Left carriageway and crossed central reservation 7 Left carriageway offside 8 Left carriageway – offside and rebounded

CARRIAGE WAY TYPE OF MARKINGS LIGHT CONDITIONS

1. Roundabout (on circular highway) 2. One way street 3. Dual carriageway – 2 lanes in each direction 4. Dual carriageway – 3 or more lanes in each direction 5. Single carriageway – single track road 6. Single carriageway – 2 lanes (one each direction) 7. Single carriageway – 3 lanes (2 way capacity) 8. Single carriageway – 4 or more lanes (2 way) 9. Unknown

DAYLIGHT 1. Street lights present 2. No street lights present 3. Presence of street lighting unknown

DARKNESS 4. Street lights present and lit 5. Street lights present nu unlit 6. No street lighting 7. Presence of street lighting unknown

SPEED LIMIT (M.P.H) WEATHER

1. Fine 2. Rain 3. Snow 4. Fine (High winds contributed) 5. Rain (High winds contributed)

6. Snow (High winds contributed) 7. Fog or mist (if hazard) 8. Other 9. Unknown

JUNCTION DETAIL

0. Not at or within 20m (22yds) of junction 1. Roundabout 2. Mini roundabout 3. ‘T’ or staggered junction 4. ‘Y’ Junction

5. Slip road 6. Crossroads 7. Multiple junction 8. Using private drive or entrance 9. Other junction

ROAD SURFACE

1. Dry 2. Wet / damp 3. Snow 4. Frost / Ice

5. Flood (surface water over 3cm [1”] deep) 6. Oil or diesel 7. Mud

JUNCTION CONTROL SPECIAL CONDITIONS

0. No crossing facility within 50m (55 yds) 1. Zebra 2. Zebra crossing controlled by S.C.P 3. Zebra crossing controlled by other authorised person 4. Pelican 5 Other light controlled crossing 6. Other sights controlled by S.C.P 7. Other sights controlled by other authorised person 8. Central refuge – no other controls 9. Footbridge or subway

0. None 1. A.T.S – out 2. A.T.S – defective 3. Permanent road signs or markings defective or obscured 4. Road works 5. Road surface defect (not including oil, water etc.)

CARRIAGEWAY HAZARDS

0. None 1. Dislodged load 2. Other object (not including pedestrians or other motor vehicles). 3. Involvement with previous accident 4. Dog in carriageway 5. Other animal in carriageway

Special projects M.P. Special projects

DTp.:

CAUSATION FACTORS This section must be filled in by the Officer reporting the collision/accident. This information is required for intelligence led enforcement activity.

Please show up to three main causes of the collision/accident in order of priority by writing numbers 1, 2, and 3 in the relevant boxes.

1. Drunk

2. Drugs

3. Driver aggression

4. Excessive speed for conditions

5. Following too close

6. Failure to comply with a) ATS* / b) Pedestrian crossing

7. Fail to give precedence at pedestrian crossing

8. Failure to comply with traffic sign*

9. Failure to signal

10. Failing to observe a hazard

11. a) Fatigue* / b) Distraction of driver* / c) Use of mobile phone*

12. Overtaking

13. Improper use of lanes

14. a) Turning right* / b) left* / c) U turn*

15. a) Defective* / b) Inattention / c) Lights*

16. Cyclist – a) Inattention* / b) Lights*

17. Pedestrian – a) Lack of familiarity* / b) Attention* / c) Confused*

18. Foreign – a) Pedestrian / b) Driver

19. Parked vehicle – a) Parking restrictions* / b) Obstruction*

20. Vehicle defects – a) Tyres* / b) Brakes* / c) Steering* / d) Lights* / e) obscured view* / f) Load – type, manner etc.*

21. Other, please specify as simply as possible