Liability / Contact / Non-Contact / 2 or more ODOT / ODOT only / Fixed Object / Citation / Custom Mailbox
District / Rpt Completion Date / ARN No. / Case # No
Occurrence Date / Time / County
Location / MP
ODOT #1 / ODOT #2
Employee Name
Drivers Lic # & Type
Supv & Date Notified
Location Type
Work Detail
Vehicle Lic / Equip #
Vehicle/Make/Model
Load Contents
Defects
Damage Amt.
Damage Description
Contributing Factor
Citation
Authorized Use / Yes- Assigned Official Business / Yes - Assigned Official Business
Safety Inv/Rep / ODOT Injuries
LEA & Report# / Object Struck
Traffic Control / Report @ Scene? Station?
Weather/Road/Light / Reported only? No Report?
Drug Test Conducted? / ODOT Passengers (Y/N)
ODOT Passenger Names:
ODOT only description & comments:
OVARS Worksheet page 2
OVARS Worksheet pg.2
Driver/Owner / Ins Info
Claimant / Insurance
Phone/Work # / Phone #
Cell # / Policy #
Address / Claim #
City, State, Zip / Agent
Owner / Phone #
Address / Injuries
City, State, Zip / Passengers
Phone/Work# / Drive able
Cell # / Towed To
Claimant Lic # / Towed To Address
Type/Vehicle / Load
Year/Make/Model / Traffic Control
Damage / Contributing Factor
Damage Amt. / Citation
Description & Comments:
To be completed for any accident with “Unknown” ODOT driver.
ODOT vehicles (listed above) were in the area at date, time and location of alleged accident
No ODOT vehicles or equipment in area at date, time and location of this alleged accident.
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