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Im <br />09 <br />Mayfield Village Vehicle Accident Investigation Form <br />Date of Accident: Time of Accident: Location: <br />Name of Employee: Department: <br />Vehicle Involved License Plate: Make: <br />Did the Department Head respond to the scene? Yes No <br />Model: <br />Did Police Respond to the scene? Yes No Police Report Number: <br />Were there any reports of injuries? Yes No Did EMS Respond to Scene? Yes <br />Was anyone transported to the hospital? Yes No <br />Describe Incident: (Sequence of events, cause, and damage to vehicles). <br />Describe any injuries: <br />Recommendations: <br />Department Head Name: Date Submitted to Mayor: <br />Ce Signature: <br />No <br />