Roadside Breakdown Record
Where the vehicle stopped, and how that was described to the recovery operator.
Vehicles and transport · RV-438 · Record
Free printable accident and claim record — the scene, the other parties, the witnesses and every contact with the insurer. PDF and fill-in-online versions.
One page. The A4 and US Letter files are laid out identically, so neither is shrunk to fit.
Print it and write on it
Fillable PDF type and save
Or no download needed
Fill it in onlineThe fillable versions have real form fields — open them in any PDF reader, type into them and save. Printing help.
The same sheet, on screen. Tick, type, add or remove rows, then print it or download the completed version as a PDF. Everything stays in your browser — your entries are kept in this browser's own storage on this device, nothing is uploaded, and there is no account.
One sheet per incident, from the roadside to the settled claim. The list covers what to gather at the scene; the first table holds the other drivers, their insurers and the witnesses, and the second a dated line for every call and letter.
Any driver after a collision, however small, and anyone helping a family member through a claim who needs the story in one place rather than across a phone, a notepad and three envelopes.
The printable is laid out inside a box that fits both A4 and US Letter, so the two files are identical and neither one is scaled. The fillable PDF has real form fields. The online version keeps what you enter in your own browser and builds the completed PDF on your device.
Download the A4 or US Letter file to match the paper in your printer, open it in a PDF reader and print at 100% — not "fit to page", which shrinks the writing space. Both files leave a 14 mm margin, which clears the unprintable edge on home printers. To print the online version with your entries in it, use the Print this sheet button, which prints only the sheet and none of the page around it. More on printing.
Both vehicles from several angles, the damage close up, the whole scene showing the road layout and any signs or markings, and the registrations. Take more than you think you need; you cannot go back.
What has to be reported, to whom and how quickly is set by the rules where you are and by your own policy. The sheet has rows for any reference you are given; check the requirements locally and with your insurer.
Write what you saw and what was said rather than a conclusion. The sheet is a record of facts and contacts; deciding liability is a matter for the insurers and, if it comes to it, for lawyers.
Yes. Fill in the scene details and leave the other-party rows for whatever you can find — a note left on the windscreen, a shop's camera, a witness who saw it.
Where the vehicle stopped, and how that was described to the recovery operator.
Every renewal date for the vehicle in one place, with the provider and the reference.
Which documents the vehicle has, who issued them and the reference to quote.
Printable sheets, workbooks and tools on the same subject.
Capture an incident properly on the day, in the affected person's own words, with the witness details and equipment notes that become impossible to gather later.
Fill in once the details you are asked for by a garage, an insurer, a parts counter or a hire firm and can never find.
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