Illinois State Police

Telephone Crash Reporting Form

Use print icon on browser to print copies as needed for your information and information for other driver(s).

Name: ___________________________________________________________________

Address: _________________________________________________________________

City: ____________________________   State: _______________  Zip: ______________

Telephone: ____________________________________________

Driver's License Number: _________________________________

LOCATION OF CRASH

Highway: ________________________    N/S/E/W of: ____________________________

Date of Crash: ____________________   Time of Crash: ___________________________

VEHICLE INFORMATION

Make: _______________________  Model: ______________________  Year: _________

License Plate Number: _______________________________________   Year: _________

Vehicle Identification Number (VIN): ___________________________________________

VEHICLE INFORMATION, IF OTHER THAN OWNER

Name: ___________________________________________________________________

Address: _________________________________________________________________

City: ____________________________________   State: _________  Zip: ___________

Telephone: _______________________________

AUTO INSURANCE INFORMATION

Company: _________________________________    Telephone: ___________________

Policy Number: _____________________________