Report • CampusOptics

This form is used to document any accident, collision, or other incident involving a motor vehicle owned, leased, or operated on behalf of Stephen F. Austin State University (SFA). The driver and department custodian responsible for the vehicle should complete this form as soon as possible following the incident. Please provide complete, accurate, and factual information.

Location Instructions

Enter the location name where the accident occurred in the fields below.

For an on-campus accident, type the name of the outdoor area in the Location field and select the appropriate option that appears.
For an off-campus accident, type “Off Campus” in the Location field and select the Off Campus option that appears.

Add Supporting Documents Instructions

If available, please attach any photos, police reports, or other documentation related to the incident.

Reporter Info

Email Address* Required

Phone Number* Required

First Name* Required

Last Name* Required

Location

Name* Required

Additional Location Details

Exact Location

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TIME AND PLACE OF ACCIDENT

Date and Time AM/PM* Required

Address* Required

City* Required

State* Required

Was police/law enforcement contacted or called to the scene?* Required

Were emergency services contacted or called to the scene?* Required

EMPLOYEE INVOLVED IN ACCIDENT

Employee ID Number (CID)* Required

Driver's Full Name* Required

Driver's Phone* Required

Driver's Department* Required

Driver's Address* Required

Driver's License Number

License Expiration Date:* Required

State Issuing License:* Required

Driver License Class Held at the Time of the Accident?* Required

Is the driver's license a Commercial Driver's License (CDL)?* Required

Is the employee an authorized driver for the University?* Required

Was the employee/driver injured as a result of the accident?* Required

Was medical treatment received?* Required

UNIVERSITY VEHICLE

License Plate Number* Required

Vehicle Year* Required

Make* Required

Model* Required

VIN* Required

Was the university vehicle being used for official university business?* Required

UNIVERSITY VEHICLE PASSENGERS

Were there passengers in the university vehicle?* Required

HOW DID THE ACCIDENT HAPPEN

Provide a Detailed Description of the Accident* Required

DAMAGE TO UNIVERSITY VEHICLE

Damage to University Vehicle* Required

OTHER DRIVER AND VEHICLE OR PROPERTY INFORMATION (OTHER PARTY)

Did the incident result in damage to another party’s vehicle or property?* Required

OTHER DRIVER / PASSENGER INJURIES

Did the other driver or passenger report an injury?* Required

WITNESS INFORMATION

Were there any witnesses to the accident?* Required

EMPLOYEE/DRIVER STATEMENT AND SIGNATURE

I certify that the information provided in this statement is true and accurate to the best of my knowledge. I understand that providing false or misleading information may be subject to disciplinary action.

ELECTRONIC SIGNATURE OF UNIVERSITY DRIVER/EMPLOYEE

* Required

Date of this Report* Required

Add Supporting Documents

Add files to upload as supporting documentation along with your incident.