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Alameda County, CA, acgov.org

Employee Incident/Accident Reporting Duties

INJURY, DEATH, OR PROPERTY DAMAGE - All accidents (vehicle and non-vehicle related) involving injury, death, or extensive damage must be reported immediately to local law enforcement. Significant injury or death losses must be reported by phone immediately, or as soon as possible, to Risk Management (Janette Brook, General Liability Program services at (510) 272-6920 or tie-line 2-6920).

County Employee’s Responsibility in the event of an Incident/ Accident

  1. If occupying a motor vehicle, stop the vehicle immediately in a manner that will clear traffic lanes and not present a hazard to moving traffic.
  2. Determine if there are any injuries and render aid to the best of your ability. Call 911 for qualified medical assistance and local law enforcement.
  3. Exchange identifying information with all parties. Motor vehicle related losses need vehicle information (year, make, model, plate number and name, address, insurance policy number of registered owner).
  4. Do not discuss fault, liability, or responsibility for the incident/accident.
  5. If possible, take photos of any damaged property and forward with incident/accident reports.
  6. If in a motor vehicle loss, contact the County garage and be prepared to give identifying vehicle and location information. Advise if vehicle can be safely driven.
  7. If the accident involves a minor (under 18), notify the parents or guardian immediately or as soon as possible. Remain with the minor until the parents/guardian arrive and obtain as much identifying information as possible.
  8. Complete the Vehicle Accident/Vehicle Incident Report (Form 430300-1) (Word - 309kb)** form if motor vehicle related. Email the completed form to Risk Management at VAR_IRF@acgov.org and send the original to the Motor Vehicle Division. For all other incidents, complete the Alameda County Incident Report Form (non-vehicle related) (Word - 256kb)* . Email the completed form to Risk Management at VAR_IRF@acgov.org.

Incident/Accident Report Form

  1. The Alameda County’s Incident or Accident Report forms must be completed within 24 hours from the time of the actual loss or the time it was discovered. All spaces and boxes on the form must be completed in entirety. If they are not applicable, write N/A. The form must be signed by the reporting employee and his/her supervisor and be submitted by email to Risk Management at VAR_IRF@acgov.org. If email is not available, submit by QIC 28505. If applicable, send the original to the Motor Vehicle Department. The completed forms are Confidential and Attorney-Client Privileged and should only be accessed by County Departments.
  2. If the County employee or supervisor is contacted by one of the following persons, a statement regarding liability is not to be given to the individual without first contacting AIMS (third party administrator) or Risk Management.
    1. the person who suffered the injury or property damage, or
    2. personal insurance carrier of the person who suffered the injury or property damage, or
    3. the employer’s insurance or attorney of the person who suffered the injury or property damage.

* Portable Document Format (PDF) file requires the free Adobe Reader.

** File requires Microsoft Word. If you do not have Word installed, you can download a free reader.

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