ACCIDENT

REPORT

VEHICLE NO: HR55AC7689

Date of Accident: 16-03-2019

PREPARED BY: Raktim Jena

MOBILE NO: 97772 22293

Contents
INCIDENT SUMMARY.................................................................................................................................................3
 Crash Diagram..........................................................................................................................................................3
Description.................................................................................................................................................................3
Weather Condition........................................................................................................................................................4
Investigation Details.....................................................................................................................................................4
Pilot Details...................................................................................................................................................................4
Trip Details.................................................................................................................................................................... 5
Cross Doc Details.........................................................................................................................................................5
Statement (Third party Driver)....................................................................................................................................5
Road Type..................................................................................................................................................................... 5
ROAD CONFIGURATION...........................................................................................................................................5
Trimble Graph...............................................................................................................................................................6
Cause of Accident........................................................................................................................................................6
Preventive measures...................................................................................................................................................6
Pictures...........................................................................................................................................................................7
Left Side....................................................................................................................................................................... 7
Right Side ....................................................................................................................................................................7
Front Side.................................................................................................................................................................... 8
Back............................................................................................................................................................................. 8
Resting position – Rivigo.............................................................................................................................................8
Resting position – Third party.....................................................................................................................................9
Road skid marks........................................................................................................................................................10
INCIDENT SUMMARY
(What, Where & How explanation after investigation)

Crash Diagram

Description
HR55AC7689 :- 11519-Bibhisan Mahanta

Vehicle HR55AC7689 is on the way to Keonjhar from CWH Kolkata, At bidysagar toll gate one LMV tried
to cross our vehicle from left got scratched itself.

Weather Condition
1. Dry/Sunny/Foggy/Rainy- Dry
2. Visibility- 10 meters

Investigation Details
Pilot Details
1. Traffic Congestion: High
Pilot Name- Bibhisan Mahanta
2. Resting position
Vehicle No- HR55AC7689
i. Rivigo Vehicle-Deep left side of road
ii. Third party vehicle-In left of RIVIGO Vehicle
Pilot
3. Id- KDJP1/DR-T/H/11519
Injury - None
Pilot Skid marks-
4. contact 0
No- 9938530721
5. Alcohol Involvement
Pilot DOB- i. Rivigo Pilot- No
ii. Third party-No
Pilot Driving License No-
6. Tyre Condition: Good
Validity of Driving
7. Brakes: License
Adjusted tillleaving
before - PS
8. Steering wheel: Ok
9. Headlights: Broken
10. Indicators - Ok
Rest before duty- Yes
Previous record-Satisfactory
Accident record - None
Months of Service: < 3 Month

Trip Details
Client-
Trip code-
Route-
Previous PS- Next -
Vehicle type- 32FT
Time of accident- Speed of Vehicle at the time of accident-
Accident site distance from PS-
Vehicle used for cross dock- NO

Statement (Third party Driver)

Third party Driver: No Statement

Road Type
Express Highway  Yes Country R. No 
Highway NH Private road No 
City road No Secondary R. No

ROAD CONFIGURATION
Road in  Yes Accident spot in No Accident spot on   No
Straight line? Curve/turn? Bridge?
Accident spot  No Accident spot  No Accident spot in  No
at including Tunnel?
Intersection? Pedestrian &
Walkway?
Accident spot  No Accident spot in  No Accident spot No
in Market Parking area? have divider?
Place?
Dry Road? Yes Wet/Slippery/muddy No Poor
Road? shape/Potholes
Road?
 Is Accident No Approximate  10
spot on Slope Visibility Distance in
meters
(25, 50, 75, 100)
Mention No of 1 Width of road (in  20 ft
Lanes at Meter)
accident spot?

Trimble Graph

Cause of Accident
(real contributory factors due to which this accident had happened)

Factors
Pre Crash
Pilot Vehicle Infrastructure/Environment

Rivigo Attentive Driving -

Third party - -

Preventive measures
(Corrective and preventive actions basis the Causes of accident)

 Control on speed

Pictures

Left Side

Right Side

Front Side
Back

Resting position – Rivigo

Resting position – Third party

Road skid marks