Vehicle accident review form: a preventability decision for every NEMT crash

This form is the page the review group fills in after a crash, once the driver has written up the event on the incident report. The incident report records what happened. This form decides whether the company calls the crash preventable and what changes because of it. The program around it, including how often reviews are held and what the points and discipline steps are, belongs in your written fleet safety program. The steps for gathering evidence are in the incident investigation guide.

How to use this form

Hold the review once the police report, any video, and the driver’s written account are on file, and complete one form for every crash, however small. The OSHA, NETS, and NHTSA guidelines for employers ask that all crashes, regardless of severity, be reported to a supervisor and then reviewed for their cause and for whether they were preventable. A scraped mirror on a loading dock gets the same form as a collision.

• Reviewers. Two or three people who were not in the van. In a small company that can be the owner, a senior driver, and the person who took the first call. The driver gives a statement and does not vote.
• Two separate boxes. Part 1 records who was cited. Part 3 records preventability. A driver can be cleared by the police and still have a preventable crash.
• Write the step, not the blame. The reason line in Part 3 names something the driver could have done, or says plainly that nothing was available. Words like “careless” do not help the next review.
• Keep it with the crash file. Staple it to the incident report, the police report number, and any footage.

The form

The form has five parts: the crash facts, the preventability questions, the decision, the driver’s account, and what happens next.

Part 1: Crash facts (copy from the incident report)

Part 2: Preventability questions by crash type

Pick the crash type, then check each line that the file shows to be true. A line left unchecked points toward preventable. If the crash fits two types, use both lists.

The van backed into something

• the driver walked around the van or had a spotter before backing.
• backing was the only way out, with no pull-through or other spot on the property.
• the driver stopped again when a mirror, camera, or person showed something behind the van.
• the van was moving at walking pace or slower.

Backing into a fixed object meets the federal test in most cases. The useful question is what the pickup needs, and the backing guide covers address notes and spotters.

The van ran into the back of another vehicle

• the gap to the vehicle ahead was enough to stop at the speed driven, on that road surface.
• the driver’s eyes and hands were on the driving, not on a phone, a navigation screen, a dispatch message, or a rider.
• traffic signals and brake lights ahead gave warning in time.

If a brake or tire defect contributed, check the van’s maintenance log: was the defect reported, or should the last inspection have found it? A defect nobody could have found points toward not preventable.

OSHA’s employer page notes that systems and procedures for dispatching and rerouting vehicles can cause cognitive, visual, and manual distractions. If the crash followed a message or a reroute, say so on the form.

An intersection or a turn

• the driver looked for cross traffic before entering, even on a green light or with the right of way.
• speed was at or below the limit, and slow enough for the view available.
• where a parked vehicle, truck, or hedge blocked the view, the driver stopped or crept until it cleared.
• the leg was on time, or the schedule left a safe way to make the pickup.

The last line comes from OSHA’s guidance that workloads and work schedules should allow employees to drive at a safe speed. FMCSA lists a crash caused by another motorist failing to stop at a traffic control device among the types it will review for a not-preventable decision. When another driver ran the signal and the van entered legally at a safe speed after looking, the video and the police report carry your answer.

The van was struck while stopped or parked

• the van was stopped for a signal, a stop sign, or traffic, or was legally parked.
• it was clear of the travel lane, the crosswalk, and any no-stopping zone, with hazard lights on while loading.
• the brake lights and hazard lights worked.
• the driver did not stop suddenly or without a reason.

FMCSA’s program lists a commercial vehicle struck in the rear, struck on the side at the rear, and struck while legally stopped at a traffic control device or parked, including unattended. Four checked lines on this list point to not preventable.

The van struck an animal

• speed was at or below the limit and suited the light and the area, such as dusk, dawn, or a posted deer crossing.
• the driver braked in the lane instead of swerving into another lane, a ditch, or oncoming traffic.

FMCSA lists an animal strike among the crash types it reviews. The federal standard excludes steps that risk “another kind of mishap,” so braking and holding the lane is the kind of step the standard expects. The deer strike guide covers the paperwork.

Anything else (weather, a mechanical failure, a lane change, a rider’s action)

Describe what the driver could have seen coming. Then describe the steps within the driver’s control, and say whether any of them would have risked a different crash. For a mechanical failure, write when the part was last inspected and whether anyone reported a warning.

Part 3: The decision

The federal test, paraphrased from FMCSA’s safety rating rules: the crash was preventable when a driver with ordinary judgment and foresight could have seen it coming as a possibility, and had steps within the driver’s control that would have avoided it without risking a different kind of mishap.

Part 4: The driver’s account

Part 5: What happens next

• No action: not preventable, and the file is complete.
• Coaching conversation, recorded in the driver’s training log.
• Retraining or a ride-along, using the road test form.
• Written warning or points under the company system, using the write-up form.
• Change to dispatch, such as an address note, a different pickup spot, or more time between legs.
• Van repair or re-inspection before it returns to service.
• Reported to the broker (date) and to the insurer (date).
• Added to the preventable crash count for the quarter.

Reviewed by: ____________________ Date: ____________ Next review of this driver or van: ____________

Why “preventable” is not the same as “at fault”

Preventable means the driver could have avoided the crash, and at fault means someone is legally responsible for it. Preventability is the company’s finding about what the driver could have done. Fault is a legal question that insurers, courts, and police decide, and the form keeps the two in separate boxes. In its crash preventability program, FMCSA states that its determinations do not establish legal liability, fault, or negligence by any party, and that fault is generally decided in civil or criminal proceedings. Write your own finding the same way: in terms of the driver’s options, not of blame. Ask your insurer or lawyer before you share a finding outside the company.

What to do when the reviewers split or a document is missing

A majority of the reviewers decides, and the form records the one who disagreed. When a police report, a video, or a repair finding has not arrived, choose “cannot tell yet,” write the missing item and a date, and decide when it comes. FMCSA’s own program works this way: documents it requests and does not receive within 14 calendar days can lead to an “Undecided” determination instead of “Not Preventable,” and the burden of showing a crash was not preventable falls on the person who submits the request. Do not leave your own decision open past the date you wrote on the form.

A crash with video of the whole sequence is the easiest to decide. FMCSA’s program accepts crash types outside its list when a video shows the sequence of events, so dash camera footage is worth keeping long after the repair. The dash cam guide covers preserving it.

How brokers read the same crash

Broker contracts can presume the driver was at fault until shown otherwise, so attach the evidence. MTM’s Pennsylvania provider agreement treats a driver as at fault after a citation, after negligent contribution, or after a single-vehicle crash that equipment did not cause. It begins from the assumption that the driver is to blame and leaves it to the driver to bring evidence or documentation, with police report copies required to verify a “no fault” accident. CareOregon’s manual describes its brokerages as treating every grievance and incident as possibly valid and preventable until the paperwork shows otherwise. The police report number, the video, and the reasons on this form are that documentation.

Pulling the facts into the form

Part 1 is mostly copying. In HealthRide, each trip leg shows its driver, vehicle, scheduled and actual times, and GPS-recorded miles, so the leg number, the minutes late, and the van all come from one record. The trip log exports as a spreadsheet or a PDF from reports. The preventable count you total each quarter feeds the accident rate per million miles.