Data Classification: Internal Use

SFM Accident Reporting Form
SASS-003B
(Rev. 03/2017)

Page 1 of 4

Date / Time
LocationofAccident
County / City / Route no.
Where is the vehicle located now?
YouandyourStateVehicle:
AgencyName
AgencyAddress
Year& Make / LicensePlateNo.
Name / Driver’s License no.
Address / Office Phone
OtherVehicle
Yearand Make / License Plate No. & State
Name / DL
Address
InsuranceCompany
Policyno.
Did thepoliceinvestigate thisaccident? / Yes No
If so,whichpolice department?
Was anyone chargedwith aviolation? / Yes No
Ifso,who, andwhatwasthecharge?
Was anyone injured? / Yes No
If so,who?
Whatwasthenatureof the injury?

Data Classification: Internal Use

SFM Accident Reporting Form
SASS-003B
(Rev. 03/2017)

Page 1 of 4

Statement

Inyourownwords,givethecircumstancesoftheaccident.

Returnthisformbymailorfaxwithin10daysofthedateoftheaccident.

SCDepartmentofAdministration

DivisionofStateAgenciesSupportServices

StateFleetManagementOffice1430SenateStreet,3rdfloorColumbia,SC29201

Fax:803-737-1160

SFM Accident Reporting Form
SASS-003B
(Rev. 03/2017)

Page 1 of 4

Telephone Numbers

EmergencyMedicalService(EMS)

CharlestonArea...... (843)745-4000

LexingtonCounty...... (803)359-2521

RichlandCounty...... (803)254-3061

Emergency...... 911

LawEnforcement

HighwayPatrol(ColumbiaArea)...... (803)896-9621

HighwayPatrol(CharlestonArea)...... (843)740-1650

HighwayPatrol(GreenvilleArea)...... (864)768-1503

RichlandCountySheriff...... (803)691-9000

LexingtonCountySheriff...... (803)785-8230

ColumbiaPoliceDepartment...... (803)252-2911

CharlestonCityPolice...... (843)577-7074

Emergency...... 911

StateFleetManagement

LeaseFleetAccidentCoordinator...... (803)737-1982

LeaseFleetManager ...... (803)737-1515

LeaseFleetAdmin.Asst...... (803)737-1516

StateFleetManager...... (803)737-0668

SafetyOfficer...... (803)737-0668

RepairstovehiclesoutsidetheColumbiaarea(CVRP)...... (800)277-3686

Data Classification: Internal Use

SFM Accident Reporting Form
SASS-003B
(Rev. 03/2017)

Page 1 of 4

Accident Procedures

• Turnignitionoffandevacuatevehicle.Assistanypassengersinyourvehicletoevacuateaswell.
• RenderFirstAidtoanyinjuredpersons(ifcertifiedtodosobyyouragency).
• Callformedicalassistanceorambulanceifrequired(seepage2forphonenumbers).
• Calllocal,municipalorcountypoliceorSouthCarolinaHighwayPatroltoreportaccident(seepage2fortelephonenumbers).
• Obtaindataconcerningothervehicleanddriver,andcompleteAccidentReport(seepage1).
• TurnAccidentReportintoyoursupervisorassoonaspossible.RemindsupervisorthatacopyoftheAccidentReportpolicereportshouldbepromptlysenttoStateFleet,ifyouweredrivingaLease

orMotorPoolVehicle.

• Givetheotherdriveryournameandyouragency’snameandaddress.NEVERADMITRESPONSIBILITYFORANYACCIDENT.
• Within24hours,besureyouragencyreportsaccidenttoAmericanSouthernandtoStateFleetManagement.

• Collectcallswillbeaccepted.

AmericanSouthern

1611DevonshireDr.,Suite102

Columbia,SC29204

Tel800-713-2205

Fax803-256-0861

SCDepartmentofAdministration

DivisionofStateAgenciesSupportServices

StateFleetManagementOffice1430SenateSt.,3rdfloorColumbia,SC29201

Tel803-737-0668(callcollectifnecessary)Fax803-737-1160

Data Classification: Internal Use