Incidents & Accidents


As a result of requests for assistance with Risk Management for larger operations and multiple locations, Berkley North Pacific has designed forms to be used internally by our insureds to help them in their own information gathering after incidents or accidents. This includes getting information and statements from witnesses, providing a format for accident investigation (the who, what, when, where and how) and some general guidelines for accident and incident prevention.

While ultimately being useful when presenting a claim, our customers have found such reports to be useful as indicators for business operation improvements, including:


·         Problems with traffic flow

·         Areas of training needed

·         Additional safety measures to institute or update

·         Issues with vendors

·         Housekeeping problems

·         Management needs at specific business locations


We hope you find these forms to be of use for your business.  If you have specific questions about Risk Management or Claims, please contact your Berkley North Pacific Agent.   


Accident and Incident Investigation Form

Restaurant Injury or Incident Report

Car Dealer Injury or Incident Report 

Car Dealer Motor Vehicle Accident Report

General Accident or Incident Report


Disclaimer: These forms are provided as courtesy and are to be used solely for information gathering for your business.  No coverage or consultation is intended or provided by the forms.

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