Accidents and injuries

Incident and records organizer

Use this page to put the facts of an injury in one place. Fill it in on screen or print it and write on it. What you type stays in this browser on this device; nothing is sent to us or anyone else.

Fill in what you can. Blank spaces are fine.

What happened

The basics, as best you remember them.

Date it happened

Where it happened (address or description)

How it happened, in your own words

Weather, lighting or anything unusual at the scene

Reports and claim numbers

Any number someone gave you.

Police or incident report number, and who took it

My insurer and claim number

The other side's insurer and claim number

Adjusters I have spoken to, and when

People involved

Who was involved, and who saw it.

The other driver, owner, company or person

Witnesses and how to reach them

Where you have been treated

Every visit, including the emergency room, therapy and follow-ups.

Doctors, clinics and hospitals, with dates

Medications and equipment (braces, crutches)

Time and money lost

The everyday details that are hardest to remember later.

Days of work missed

Costs you have paid (receipts kept?)

Things you could not do because of the injury

Evidence you are keeping

Photos, damaged items, messages.

What I have kept, and where it is

Your questions

What worries you most, and what you would like to ask a lawyer.

What worries me most

Questions I want to ask